Pneumopericardium may be defined as the presence of air within pericardial cavity which results due to spontaneous or iatrogenic cause. It is rare but life threatening entity, commonly caused by respiratory distress syndrome and vigorous resuscitation, in the paediatric population. Although, pneumopericardium is often asymptomatic, it may cause chest pain, dyspnoea and subcutaneous emphysema. The course of pneumopericardium is usually benign and self-limited. Treatment is crucial in tension pneumopericardium, a complication of pneumopericardium. Here, we report a case of pneumopericardium in a nine month old male child after vigorous resuscitation and intubation for respiratory distress syndrome. DOI: http://dx.doi.org/10.3126/jnps.v34i2.11152 J Nepal Paediatr Soc 2014;34(2):163-165