The pericardium is a thin fibroelastic sac, comprised of both a serous visceral and fibrous parietal layer, which surrounds the heart and the great vessels and is subject to a spectrum of disease assess by cardiac imaging. Echocardiography remains the initial imaging modality of choice and should be performed as a complete study or as a point of care when suspecting acute pericarditis, constrictive pericarditis, pericardial effusion, and cardiac tamponade. The presence of an abnormal septal motion from right to left in early diastole during inspiration, a plethoric IVC, and evidence of ventricular interdependence are the cornerstones of constrictive pericarditis physiology. The location, size, extent of the pericardial effusion and presence of loculations should be characterized using all four echocardiographic windows. Chamber collapse is an important indicator of the presence of tamponade physiology along with a septal bulge and peak mitral and tricuspid E-inflow velocity respiratory variation. Most cases of cardiac tamponade are treated with needle pericardiocentesis.