Pericardial fat masquerading as tumor

A 65-year-old woman was evaluated for fatigue, malaise, and atypical chest pain. One year prior she had undergone subtotal gastrectomy and jejunostomy in treatment of a large gastrointestinal stromal tumor. Two-dimensional echocardiography was performed, which showed a small circumferential pericardial effusion with a soft tissue echo density attached to the right atrial/right ventricular junction that extended over the right ventricle. Because of concern about possible malignant disease, thoracoscopy and biopsy of the pericardial mass were recommended. Normal fibro-adipose tissue was found with no evidence of neoplasm. Pericardial fat deposition is common in multiple conditions. It can be found in any location but is most common over the anterior portion of the heart. In this case, the concomitant presence of a small pericardial effusion and prominent fat pad at the right atrial/right ventricular junction gave the appearance of pericardial tumor.