An 84-year-old man presented with cardiogenic shock. A computed tomography scan revealed a massive pneumopericardium (A), and an emergency computed tomography-guided drain (red arrow, B) evacuated air and turbid fluid. An oral-contrast computed tomography scan detected a pericardial opacification through an oesophagopericardial fistulation (red arrows, C) of a previously unknown oesophageal tumour, as subsequently confirmed at endoscopy (white arrows, D). A coated expandable metal stent was placed (E), but, despite intensive care therapy, the patient died 4 days later due to uncontrolled sepsis.