| A 62-year-old man with multiple nontender skin nodules is presented. Some of these nodules discharged a purulent looking fluid. At presentation, the patient did not have any other complaints. No infectious, neoplastic, or immunologic origin could be found for the nodular rash. Biochemical profile, imaging, and skin biopsy confirmed the diagnosis of disseminated fat necrosis (DFN) accompanying asymptomatic pancreatitis. The process involved the mesenteric, subcutaneous, and intramedullary fat. The skin lesions were surgically treated. Mesenteric and intramedullary fat necrosis were watched closely. A year later, the patient was readmitted with a diagnosis of pancreatitis. Subcutaneous and intramedullary necrosis were completely resolved at this time, and only mesenteric fat necrosis prevailed. The clinical syndrome of DFN, its etiology, pathophysiology, treatment, and prognosis are discussed. ( info) |
12/191. Encapsulated fat necrosis--a clinicopathological study of 8 cases and a literature review. Eight cases of encapsulated fat necrosis are described. The patients were two males and six females from 10 to 77 years of age. The majority of the lesions clinically presented as asymptomatic, multiple, mobile, small nodules. All patients were treated by simple excisions of the nodules. Grossly, the lesions were whitish-yellow in color, smoothly-surfaced, round nodules measuring 3 to 20 mm in the greatest diameter. Histopathologically, the nodules were basically composed of variably degenerated and necrotic fatty tissue covered by fibrous connective tissue capsule associated with occasional calcification and inflammatory cell infiltrates. Among several terms proposed for this disease, encapsulated fat necrosis is considered most preferable term based on the clinical and histological findings of the present and reported cases. ( info) |
| fat necrosis of the breast is a well-known complication following trauma, surgery, or radiotherapy. The present paper describes a rare case of fat necrosis after heparin-induced thrombocytopenia. The mammographic, sonographic, and MR evaluation and pathologic correlation after a 1-year follow-up period are reported. ( info) |
14/191. Extra-hepatic biliary-ductal necrosis in acute pancreatitis: a rare complication. An 8-year-old male presented with an acute abdomen. Exploration revealed bilious ascites, oedematous pancreatitis with areas of necrosis, and omentum showing patches of fat necrosis. The common bile duct and almost all of the common hepatic duct were gangrenous and had sloughed, with bile leaking from the junctional stump of the right and left hepatic ducts. The patient was managed successfully by Roux-en-Y hepaticojejunostomy. This is a rare case showing necrosis and sloughing of the extrahepatic bile ducts in acute pancreatitis. ( info) |
15/191. Simultaneous occurrence of fat necrosis and carcinoma after breast injury in a traffic accident. An old female patient presented after a car accident with clinical and sonographic evidence of two lesions, located along the seat-belt line. Despite the recent history of trauma and the localization in the traumatized area, the discrepancy between the sonographic size of the smaller lesion and the findings on palpation, together with the lack of typical mammographic findings for fat necrosis rose the suspicion of malignancy. A fine needle aspiration biopsy was performed to confirm the nature of the smaller lesion. ( info) |
16/191. Encapsulated pericardial fat necrosis treated by video-assisted thoracic surgery: report of a case. A 55-year-old moderately obese man who was admitted to a local hospital following a traffic accident reported having experienced an episode of sharp and sudden pleuritic pain in the left anterior lower chest 2 days earlier. A computed tomographic scan on admission demonstrated a nonhomogeneous mass in the anterior left side of the chest, abutting the left cardiac margin, and a left-sided pleural effusion. As a mediastinal tumor was suspected, he was referred to our hospital for investigation and treatment. An exploratory thoracotomy was performed by video-assisted thoracic surgery (VATS) about 3 weeks later, which revealed a firm, yellowish mass on the oral side of the pericardial fat pad, adhering to the anterior chest wall. The mass was easily removed. The resected specimen consisted of a lobulated fragment of adipose tissue measuring 5.0 x 3.5 x 2.0 cm, and the final pathologic diagnosis was pericardial fat necrosis. The patient had an uneventful postoperative recovery and has remained free of symptoms for 10 months since his operation. Pericardial fat necrosis remains a rare clinical entity. Surgical excision by VATS achieves symptomatic cure and probably continues to be the treatment of choice because of the need to exclude a neoplasm in the differential diagnosis. ( info) |
17/191. Hepatic steatosis and lactic acidosis caused by stavudine in an hiv-infected patient. Lactic acidosis and hepatic steatosis caused by mitochondrial toxicity of nucleoside reverse transcriptase inhibitors (NRTI) is a rare cause of liver disease with a high mortality rate. This report describes a male, hiv-positive patient with a 4-week history of nausea, vomiting and abdominal pain. His medication consisted of prednisone 5 mg od (because of auto-immune thrombocytopenia), didanosine (for 2 years) and stavudine (for 3 months). Laboratory studies showed cholestasis and elevation of aminotransferases. Lactic level was not measured. liver biopsy revealed steatosis and cholestatic hepatitis. In the absence of other causes of liver disease a probable diagnosis of stavudine-induced hepatic toxicity was made. After discontinuation of NRTI, he recovered completely. Because lactic acidosis had not been confirmed, stavudine was restarted and within 1 week the lactate level increased significantly. Therefore stavudine was discontinued again. One year later the patient is doing well on a double protease inhibitor regimen. In conclusion, clinicians treating patients with NRTI should be aware of the risk of lactic acidosis and hepatic steatosis. When this is suspected, all NRTI must be stopped. The diagnosis can be made when elevated lactate levels and hepatic steatosis are present in the absence of other causes of liver disease. ( info) |
| Retroperitoneal fat necrosis is a well-known complication of acute pancreatitis. We describe an unusual case of fat necrosis presenting as multiple, bilateral renal pseudotumors in a patient with acute pancreatitis. The imaging findings on CT and MR are discussed. ( info) |
19/191. Calcified subcutaneous fat necrosis induced by prolonged exposure to cold weather: a case report. We present a 22-day-old infant with extensive subcutaneous calcifications due to subcutaneous fat necrosis caused by prolonged exposure to cold. ( info) |
20/191. Peripancreatic fat necrosis mimicking pancreatic cancer. A case of peripancreatic fat necrosis, after an episode of acute pancreatitis, which mimicked pancreatic cancer with lymph node metastases, is presented. We describe the imaging findings with helical CT scanning and with unenhanced and mangafodipir-enhanced MR imaging, with special emphasis on the differential diagnoses. ( info) |