Background and aim: Metabolic syndrome (MetS) includes an assembly of conditions; the most important of which is obesity. The pandemic prevalence of obesity worldwide increased the awareness of MetS. Mesenteric fat thickness is linked to higher risk of coronary artery disease (CAD) complications which may lead to death. Although many studies were done on patients with MetS worldwide, studies on Egyptian patients are limited. Thus, here we examined the relationship between mesenteric fat thickness and the severity and prevalence of CAD among Egyptian patients with MetS.