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March 26, 1982

Positive Epicardial Fat Pad Sign Without Pericardial Effusion

JAMA. 1982;247(12):1695. doi:10.1001/jama.1982.03320370013009

To the Editor.—  In a recent article in The Journal (1980;244:2762), Carsky et al described the epicardial fat pad sign (EFPS) in the diagnosis of pericardial effusion. In another article1 they reported that 52% of 100 patients with echocardiographic evidence of pericardial effusion had positive EFPS on plain chest films. They stated that a pericardial line wider than 2 mm is virtually diagnostic of pericardial fluid or thickening. Other authors2 mention pericardial thickening as a cause for widening of the pericardial line, yet no confirmed case has been reported. In 1955, Kremens3 reported a case of presumed pericardial thickening owing to fibrinous pericarditis as identified on anteroposterior planigrams of the chest. Echocardiography was not available at that time, and pericardiocentesis was not carried out. We describe a patient showing a positive EFPS with no evidence of pericardial effusion on echocardiography. To our knowledge, this would appear to