Another Chest Pain Ruled Out: A Typical Story With an Atypical Finding on a Chest X-ray (CXR) Leading to an Uncommon Diagnosis

Epicardial fat necrosis is an uncommon cause of chest pain that mimics pericarditis, pulmonary embolism, and/or coronary syndrome. This is a case of a 55-year-old female patient presenting with left-sided pleuritic chest pain. She had a normal exam and vital signs. Diagnostics showed a non-ischemic electrocardiogram with a negative troponin, an elevated D-dimer, and a chest radiograph showed an opacity along the left cardiac border. Computed tomography-pulmonary angiography (CT-PA) was performed and showed a 4.2 x 1.8 x 3.0 cm lesion, surrounded by a hyperdense ring of high attenuation with fat stranding, which diagnosed epicardial fat necrosis.