Visualization Of Subepicardial Fat Stripes

The subepicardial fat lines are important landmarks in the diagnosis of heart disease. The fat stripe is a cushion-like structure separating the myocardium from the pericardium. Normally, it is difficult to see the fat line because of the adjacent similar radiolucency of the air-filled lung. The in-between hairline density of the normal pericardium is delicate and also difficult to see except in the left lateral view (Fig. 12-10M). In the presence of pericardial effusion or thickening, the subepicardial fat line is displaced interiorly and becomes more visible because of the added background of water density (see Fig. 12-10.5). The subepicardial fat pulsates with the contracting myocardium within the immobile band of pericardial fluid. This is diagnostic of pericardial effusion.33 In contrast, when pericardial thickening alone is present, the exterior border of the heart pulsates with the fat line. This, in turn, suggests the diagnosis of pericardial constriction.

Although the displaced subepicardial fat stripe is visualized only in the lateral radiograph (see Fig. 12-10.5), fluoroscopically, the pulsating fat line is clearly visible in all four views throughout the entire cardiac cycle (Fig. 12-27).

Water Bottle Silhouette

Figure 12-27: A young man with a slowly developed pericardial effusion without cardiac tamponade. His posteroanterior view shows a huge water bottle-like cardiac silhouette. Note the lungs are clear and the PBF pattern is normal. The subepicardial fat stripe (black curvilinear line) within the immobile pericardial effusion was clearly visible and bouncing vigorously under the fluoroscope. The amplitude of excursion of the fat stripe reflected the normally functioning myocardium.

Figure 12-27: A young man with a slowly developed pericardial effusion without cardiac tamponade. His posteroanterior view shows a huge water bottle-like cardiac silhouette. Note the lungs are clear and the PBF pattern is normal. The subepicardial fat stripe (black curvilinear line) within the immobile pericardial effusion was clearly visible and bouncing vigorously under the fluoroscope. The amplitude of excursion of the fat stripe reflected the normally functioning myocardium.

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  • Marigold
    What is subepicardial fat?
    8 years ago

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