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A patient with a history of adrenocortical carcinoma presented with massive pericardial effusion and a giant pericardial mass. Death resulted from cardiac tamponade. At autopsy a large necrotic mass was histologically similar to the original adrenocortical carcinoma. Wepresent this case and review the literature on metastatic pericardial disease. (Internal Medicine: 32: 438-440, 1993)doi:10.2169/internalmedicine.32.438 fatcat:rr74rotyvjh7rlq2yh7awf2w2a