Here in we present a 74-year-old case of esophago-pericardial fistula with pericardial effusion and pneumopericardium. Bone-related esophageal trauma was the cause of the esophago-pericardial fistula. The esophago-pericardial fistula was diagnosed with echocardiography, computerized tomography (CT) and endoscopy. Pericardiocentesis was performed for drainage the pericardial effusion. The esophago-pericardial fistula was treated with covered self-expandable esophageal stent.