Epipericardial fat necrosis (EFN), also known as pericardial or mediastinal fat necrosis, has until lately been considered an unusual cause of acute chest pain. Due to increased use of computed tomography (CT) and other imaging techniques, EFN is now believed to be an under-diagnosed cause of acute chest pain. We here present a patient with a short history of acute, left-sided pleuritic chest pain and dyspnoea, with total resolution of symptoms upon few days with nonsteroidal anti-inflammatory drugs (NSAIDs) treatment. Chest X-ray showed a paracardial opacity with ipsilateral pleural effusion, echocardiography revealed features of EFN, and CT scan demonstrated the cardinal lesion of EFN—an ovoid, fat-containing paracardial mass with surrounding inflammatory stranding. There was a near to full radiological resolution in 3 weeks.