Pericardial mesothelioma is a rare and highly aggressive and lethal cardiac tumour. A 25-year-old male patient who was complaining of fever, night sweats, shortness of breath and palpitations after an upper respiratory system infection was admitted in May 2008. He had a history of 12 years exposure to asbestos. When the patient was referred to our hospital in June 2008, his complaints of palpitations and shortness of breath were continuing. He had oedema of legs and a venous swelling on his neck. The echocardiography showed pericardial effusion and pericardial thickening which were also found on the CT. Through median sternotomy a pericardectomy and tumor resection were performed. Histological and immunohistochemical findings lead to the diagnosis of malignant pericardial mesothelioma. In conclusion, there is still not a radical therapy for primary pericardial mesothelioma. Surgery is done to prevent cardiac tamponade and relieves constriction.