Surgically treated mediastinal fat necrosis: an exception to conservative treatment.

Mediastinal fat necrosis is an important differential diagnosis for acute chest pain in previously healthy patients. Imaging examination is essential to establish this diagnosis, as physical examination can be unhelpful and laboratory tests are non-specific. The treatment of choice is conservative, with non-steroidal anti-inflammatory drugs; surgery is reserved for a few selected cases. We present the case of a 37-year-old male patient with mediastinal fat necrosis, refractory to the conservative management and complicated by growing pleural effusion, which was treated surgically.