The Pericardium is a membrane like structure which envelops the heart and the proximal great vessels from all around. In normal physiological conditions, there is ~ 10 – 50 ml of pericardial fluid present. But, significant accumulation of pericardial fluid can occur in certain conditions like inflammation or infection of the pericardium and adjacent surrounding structures. This condition can remain asymptomatic for significant time period and incidentally can be found after any imaging investigations for another disease process, or patient can present with shock like symptoms due to cardiac tamponade. Here, one point is of significant notification that it is the rate of accumulation of the fluid around pericardium, and not the absolute size of the heart, that primarily determines the symptoms that occur in the pericardial effusion. Meanwhile the clinical suspicion may be introduced by the history of the patient, examination of the patient, electrocardiogram investigation, or chest X-ray. In all these, the echocardiogram is the basic and mainstay to confirm the diagnosis. Options for treatment depends on the etiology and hemodynamics consequences of the heart. This article mainly focuses on the etiology, pathophysiology, investigation, chest X-Ray, CT, and management of the pericardial effusion. Keywords: Pericardial effusion, Chest X-Ray, Moneybag appearance of Heart, Hypertension, CKD Grade V.