This case illustrates a case of epicardial fat necrosis in an otherwise well young male. The patient was managed conservatively.

The lesion could be easily missed as it is near the end of the image stack and hidden low within the epicardial fat.

The fatty liver supports the diagnosis, as obesity is often a predisposing factor.

A unilateral pleural effusion is concerning for a malignant effusion in other clinical scenarios but the unremarkable appearances of the lungs, intra-thoracic lymph nodes and the patient demographic render a malignant effusion unlikely. The effusion and lower lobe collapse are likely reactive in this setting.