Among the echocardiograms of 844 patients of the International Goodwill Hospital from January 1980 to April 1981, 700 showed clinically inexplicable extra echo spaces. Fifty of the 700 had computerised tomography of their hearts which showed the extra echo spaces to be caused either by anterior or posterior subepicardial fat. Six of the 50 cases had both fat and pericardial effusions, which are difficult to differentiate echocardiographically unless follow-up clinical observations are performed. Subepicardial fat deposits are reasonable explanations for the extra echo spaces frequently observed by echocardiography: they correlate well with clinical findings. Subepicardial fat should be recognised as the cause of such extra echo spaces.