Echocardiography is the primary imaging modality for the assessment of pericardial disease. It identifies with exceptional precision the unique pathophysiology of constrictive pericarditis. Furthermore, it accurately defines the magnitude and extent of pericardial effusion. The presence of tamponade physiology is readily established with this technology. By demonstrating the most favorable site of percutaneous entry into the pericardial space, echocardiography maximizes the safety and efficacy of pericardiocentesis. This tutorial closes with a live step-by-step instructional video of a pericardiocentesis procedure that was performed at Mayo Clinic in Rochester, Minnesota.