MINI-ABSTRACT: We report the clinical case of a 63-year-old woman with a squamous cell carcinoma in the distal esophagus complicated by an esophago-pericardial fistula and pneumopericardium. This is a rarely observed condition usually associated with a high mortality because may result in cardiac tamponade. However, as the esophago-pericardial fistula was open and the air was free to enter and exit throughout the cardiac and respiratory cycle without significantly increasing pericardial pressure, our patient showed only a mild hemodynamic impairment without overt clinical signs of cardiac tamponade.