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

## TL;DR

A 55-year-old woman with chest pain was diagnosed with rare epicardial fat necrosis after imaging revealed an unusual chest X-ray finding.

## Contribution

This case highlights a rare cause of chest pain diagnosed through atypical imaging findings.

## Key findings

- A CT scan revealed a lesion with a hyperdense ring and fat stranding, leading to a diagnosis of epicardial fat necrosis.
- The patient's symptoms mimicked more common conditions like pericarditis or pulmonary embolism.

## Abstract

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.