International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Case Report: This report describes a case of a 50-year-old male with pericardial angiosarcoma presenting with cardiac tamponade. Repeat pericardiocentesis showed bloody fluid with cytopathology negative for malignant cells. Pericardial fenestration was performed to prevent recurrent pericardial tamponade due to poor drainage. A diagnosis of cardiac angiosarcoma was made based on the resected pericardium and a biopsied specimen from gluteus medius muscle. The patient responded to combination therapy with docetaxel and radiotherapy. However, the patient died four months after diagnosis due to intraperitoneal bleeding from liver metastases. The patient was not dependent on a chest tube or a pericardial drain before he died. At autopsy, only a small amount of residual tumor was revealed around the heart. Conclusion: There is a possibility that palliative local control against refractory cardiac tamponade could be obtained via multidisciplinary therapy with pericardial fenestration, radiotherapy, and chemotherapy. IJCRI publishes