Malignant mesothelioma is the most common primary tumor of the pericardium the clinical presentation is varied and aggressive, with high mortality even with cancer treatment. We report the case of a woman of 56 with recurrent pericardial and requirement of surgical procedures for resolution, which initially presented pericardial liquid negative for malignancy and subsequent decision malignant mesothelioma was diagnosed spill. He joined our institution for therapeutic assessment and finally died of refractory heart failure.