Pericardial diseases are relatively common diseases that may affect the pericardium either as an isolated disease or often as an involvement in a systemic or underlying disease. In this setting, pericardial disease may be the first manifestation of this underlying entity.

The history and clinical presentation are essential to develop a rationale, cost-effective diagnostic and management plan.

Many findings (e.g. signs, symptoms, basic instrumental data from ECG and chest x-ray) may be non-specific and thus should be appropriately integrated into the clinical evaluation.

Echocardiography is the first-level imaging technique for all patients with a suspicion of pericardial disease, while computed tomography (CT) and cardiac magnetic resonance (CMR) should be reserved for selected cases.

Although the causes of pericardial diseases are varied, they are similarly manifested in typical “pericardial syndromes” (pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis and pericardial masses).

An epidemiological approach to the aetiological diagnosis is essential to avoid useless and expensive tests that may have limited diagnostic and therapeutic impact.

Tuberculosis is the most common cause of pericardial diseases all over the world, and this should be considered everywhere since immigration may change the aetiological spectrum of pericardial diseases even in developed countries with a current low prevalence of tuberculosis.

Nevertheless, the clinician should essentially rule out bacterial, neoplastic aetiologies and forms related to autoimmune or systemic inflammatory diseases.