Cardiac levorotation: a cause of false-positive epicardial fat pad sign

In a 60-year-old man, two chest radiographs showed an apparently thickened pericardial stripe. Echocardiography and surgery for aortic valve replacement showed no pericardial fluid or thickening. An angiocardiogram showed that the patient's right coronary artery was positioned more medially than usual because of levorotation of the heart, producing the false-positive fat pad sign.