Epipericardial fat necrosis (EPFN) is an uncommon cause of chest pain. Typically manifesting as severe acute chest pain, EPFN can be mistaken for a serious disorder, such as pulmonary embolism or myocardial infarction. We report a case of EPFN, diagnosed tentatively based on clinical and radiographic findings, with documented resolution of the lesion on chest CT. According to our literature search, this is only the second case in which chest CT alone was used to both diagnose the lesion and track its resolution. It is the first documented case diagnosed and followed as such in North America.