Pericarditis (inflammation of the pericardium) may be caused by infectious agents, autoimmune disorders, metabolic conditions, or malignancy, or it may be a complication of drug therapy, trauma, cardiac surgery, or smallpox vaccination. Diagnosis, based on clinical findings, electrocardiographic changes, chest radiograph, and ultrasound, may be confirmed as appropriate by pericardiocentesis. Although contemporary imaging technologies, such as computed tomography and magnetic resonance imaging, are useful, echocardiography remains the simplest and most expeditious noninvasive tool to assess inflammatory and infectious diseases of the pericardium. Although contemporary management of pericardial disease remains relatively unchanged, reports of innovative approaches to the management of pericardial effusion include the installation of intrapericardial thrombolytic agents to facilitate drainage of purulent effusions or balloon pericardiotomy for recurrent effusions. Both offer potential alternatives to the surgical pericardial window.