• Habib Rehman Khan Nottingham University Hospitals
  • Ayman Alatta Nottingham University Hospitals
  • Michael Sosin Nottingham University Hospitals


Advances in imaging modalities have improved diagnosis of diseases in patients allowing physicians to make earlier and accurate diagnosis with resultant improved overall outcome for patients. Sometimes, however this comes at a cost of over estimation of normal variants leading to further unnecessary investigations or in extreme cases interventions. In this article, we demonstrate three cases where epicardial fat is misdiagnosed as pericardial masses which is an example of misinterpretation of normal findings. Correct identification of pericardial fat on transthoracic echocardiograms is important in reducing misdiagnosis and also anxiety for both physicians and patients. knowledge about normal variants not only improve patients care but also reduce unnecessary investigations that are subsequently ordered for clarification.Keywords:  epicardial fat; pericardial tumours; pericardial effusion; epicardial adipose tissue; EAT

Author Biographies

Habib Rehman Khan, Nottingham University Hospitals

Cardiology Specialist Registrar

Ayman Alatta, Nottingham University Hospitals

Cardiology Specialist Registrar   

Michael Sosin, Nottingham University Hospitals

Consultant Cardiologist


Toufan M, Azarfarin R, Sadati B, Golzari SE. The association between epicardial adipose tissue and coronary artery disease: an echocardiographic cut-off point. J Cardiovasc Thorac Res 2012;4(2):31–6.

Meenakshi K, Rajendran M, Srikumar S, Chidambaram S. Epicardial fat thickness: A surrogate marker of coronary artery disease – Assessment by echocardiography. Indian Heart J 2016;68(3):336–41.

Rosito G, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: The Framingham Heart Study. Circulation 2008;117(5):605–13.

Rabkin SW. Epicardial fat: properties, function and relationship to obesity. Obes Rev 2007;8(3):253–61.

Dey D, Wong ND, Tamarappoo B, Nakazato R, Gransar H, Cheng V, et al. Computer-aided non-contrast CT-based quantification of pericardial and thoracic fat and their associations with coronary calcium and metabolic syndrome. Atherosclerosis 2010;209(1):136–41.

Ding J, Kritchevsky SB, Harris TB, Burke GL, Detrano RC, Szklo M, et al. The association of pericardial fat with calcified coronary plaque. Obesity (Silver Spring) 2008;16(8):1914–9.

Yerramasu A, Dey D, Venuraju S, Anand DV, Atwal S, Corder R, et al. Increased volume of epicardial fat is an independent risk factor for accelerated progression of sub-clinical coronary atherosclerosis. Atherosclerosis 2012;220(1):223–30.

Sacks HS, Fain JN. Human epicardial adipose tissue: A review. Am Heart J 2007;153(6):907–17.

Iacobellis G, Pistilli D, Gucciardo M, Leonetti F, Miraldi F, Brancaccio G, et al. Adiponectin expression in human epicardial adipose tissue in vivo is lower in patients with coronary artery disease. Cytokine 2005;29(6):251–5.

Gorter PM, de Vos AM, van der Graaf Y, Stella PR, Doevendans PA, Meijs M, et al. Relation of Epicardial and Pericoronary Fat to Coronary Atherosclerosis and Coronary Artery Calcium in Patients Undergoing Coronary Angiography. Am J Cardiol 2008;102(4):380–5.

Konishi M, Sugiyama S, Sugamura K, Nozki T, Ohba K, Matsubara J, et al. Association of pericardial fat accumulation rather than abdominal obesity with coronary atherosclerotic plaque formation in patients with suspected coronary artery disease. Atherosclerosis 2010;209(2):573–8.

Thanassoulis G, Massaro JM, O'Donnell CJ, Hoffmann U, Levy D, Ellinor PT, et al. Pericardial Fat Is Associated With Prevalent Atrial Fibrillation: The Framingham Heart Study. Circ Arrhythm Electrophysiol 2010;3(4):345–50.

Mookadam F, Goel R, Alharthi MS, Jiamsripong P, Cha S. Epicardial fat and its association with cardiovascular risk: A cross-sectional observational study. Heart Views 2010;11(3):103–8.

Singh N, Singh H, Khanijoun HK, Iacobellis G. Echocardiographic Assessment of Epicardial Adipose Tissue - A Marker of Visceral Adiposity. Mcgill J Med 2007;10(1):26–30.

Willens HJ, Gómez-Marín O, Chirinos JA, Goldberg R, Lowery MH, Iacobellis G. Comparision of epicardial and pericardial fat thickness assessed by echocardiography in African American and non-Hispanic white men: A pilot study. Ethn Dis 2008;18(3):311–6.

Iacobellis G, Assael F, Ribaudo MC, Zappaterreno A, Alessi G, Di Mario U, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003;11(2):304–10.

Pressman G, Verma N. Pericardial Fat Masquerading as Tumor. Echocardiography 2010;27(2):E18–20.

Iacobellis G, Willens H. Echocardiographic Epicardial Fat: A Review of Research and Clinical Applications. J Am Soc Echocardiogr 2009;22(12):1311–9.