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Epipericardial fat necrosis is a rare cause of chest pain. It presents as pleuritic pain in an otherwise healthy patient. Computed tomography has proved to be the most effective diagnostic imaging technique because of its ability to reveal typical alterations in the cardiophrenic space. As far as we know, sonographic findings concerning this entity have not been reported in the literature. We report 4 cases admitted to our institutional emergency department with chest pain. Among other tests, chest wall sonography was requested in these patients and showed special findings that should be evaluated with chest computed tomography.