Epicardial Fat Necrosis as a Rare Cause of Chest Pain

BACKGROUND: Epicardial fat necrosis (EFN) is a rare, self-limiting condition that presents as acute severe chest pain. Symptoms can mimic life-threatening conditions (myocardial infarction, pulmonary embolism, and pericarditis). CASES SUMMARY: We present 2 cases of EFN with acute, left-sided pleuritic chest pain without a clear precipitating factor. Blood work revealed elevated D-dimer, C-reactive protein, and normal troponin. Chest computed tomography (CT) scan showed characteristic EFN appearance. They were managed with nonsteroidal anti-inflammatory drugs with clinical and imaging resolution. DISCUSSION: Our cases illustrate typical examples of EFN in presenting with acute, left-sided pleuritic chest pain. Pathogenesis is unknown; incidence is around 0.26% among patients undergoing chest CT in the emergency department. CT ± cardiac magnetic resonance imaging are crucial in diagnosing the condition. Management is typically conservative, with pharmacological treatment preferred over surgical excision. TAKE-HOME MESSAGES: EFN is a rare, benign cause of acute chest pain in the emergency department. Diagnosis is typically made with CT and/or cardiac magnetic resonance imaging, and management is generally conservative.