Excess epicardial fat mass misrepresented as cardiomegaly in dry-weight assessment of a dialysis patient.

Obesity is a major health problem that has entered the nephrology community and is challenging our conventional management strategies. In this case report, we present a morbidly obese dialysis patient whom dry-weight assessment was disturbed by excess epicardial fat mass due to obesity. This case suggests that problems related to obesity seem not to be limited to dealing with obesity-associated kidney injury, chronic kidney disease and mortality, but also other concepts in nephrology such that, as described, excess epicardial fat mass related to morbid obesity in this patient erroneously suggested a high cardiothoracic index, and misled patient management. Interpretation of chest X-ray in dry-weight assessment should take into account the patient's body weight especially in obese cases and alternative diagnostic methods for correct determination of fluid status are highly needed.