Pneumopericardium is the presence of air within the pericardial cavity. Though several etiologies and pathological mechanisms for this have been described, there is no clear consensus. Most resolve spontaneously, but others may develop severe complications such as cardiac tamponade which may lead to cardiorespiratory arrest. We report a rare case of a patient who developed a tension pneumopericardium requiring emergent aspiration following a therapeutic pericardiocentesis. Radiological and echocardiographic findings of this rare iatrogenic pneumopericardium are reviewed.