Paracardial fat in HIV-infected patient resembles pericardial effusion

The presence of paracardial adipose tissue should be ruled out in HIV-infected patients on antiretroviral therapy who appear to have pericardial effusion, German investigators suggest in the May issue of the journal Heart. This may avoid unnecessary puncture of the pericardium, which could have “serious consequences,” they add.

Dr T Neumann and associates, from the University Hospital Essen, describe a 52-year-old man with a 10-year history of HIV infection who presented with exertional dyspnea. His treatment regimen included nelfinavir, nevirapine, and stavudine. His body habitus showed the effects of lipodystrophy, and serum levels of triglycerides and cholesterol were elevated.

Transthoracic echocardiography showed no evidence of impaired ventricular filling, but there was a 4mm-wide epicardial space. Repeat echocardiography 10 months later showed an increase in the epicardial space to 18mm, but diastolic function had actually improved slightly, and ventricular function still appeared to be healthy. T1 weighted turbo spin echo magnetic resonance tomography revealed the presence of adipose tissue surrounding the ventricles.

Dr Neumann’s group warns that assuming the diagnosis based only on the echocardiogram could have fatal consequences if aspiration is attempted and the ventricle is punctured in an effort to produce pericardial fluid. They suggest that “T1 weighted sequences with and without fat suppression can clearly distinguish adipose tissue from pericardial fluid,” and that computed tomography can also differentiate between the two.