Fatty infiltration surrounding the whole heart, infiltrating into the myocardium, and causing pulmonary stenosis

A 33-year-old male patient presented with complaints of atypical chest pain and exertional dyspnea of two-month history. Examinations to uncover these symptoms (physical examination, blood tests, electrocardiography, transthoracic echocardiography, coronary angiography, right heart catheterization) showed no abnormality, except for echocardiographic appearance of hypoechogenic areas suggesting widespread pericardial effusion involving the anterior and posterior cardiac walls and mild pulmonary stenosis. Cardiac magnetic resonance imaging (MRI) performed for further evaluation of the pulmonary gradient revealed fatty infiltration surrounding the whole heart, infiltration into the myocardium, and causing indentation of the proximal pulmonary artery. Since no pathologic condition associated with this radiologic appearance could be found, lipomatous infiltration was thought based on these cardiac MRI findings.