The non-traumatic cardiac obstruction has a benign etiology in the 35% of the cases and a malign etiology in the 65% of them. The malign pericardic effusion can appear due to the neoplasic invasion of the pericardium. But it also can be caused by lymphatic obstruction, radiation therapy, medications or concomitantly with infections such as tuberculosis. This anicle reports the case of a 52 year-old male with a diagnosis of a stage IIIb bronchoalveolar epidermoid carcinoma, who received radiation therapy and presents asevere pericardial effusion. This article also reviews the state-of-the-art related to pathophysiology and a diagnostic and therapeutic approach of the malignant pericardial effusion. The patient with malignant pericardial effusion sets up a challenge in the surgical practice. The approach depends on the severity of the effusion an the patient's general condition. The treatment should be focused on a short, medium or long term according to the global prognosis.