Pericardial metastases are frequently found and often cause cardiac tamponade which requires emergency treatment. Pericardiocentesis or subxiphoid pericardiotomy and pericardial drainage can be performed; the latter is a safe and effective method for the management of continuous pericardial effusion since it can be done under direct visualization and local anesthesia. We had four patients with neoplastic cardiac tamponade who were treated successfully with subxiphoid pericardiotomy and pericardial drainage. In three of them neoplasms had not been found until cytology of pericardial fluid proved to be malignant when they were attacked by cardiac tamponade. If the patient with malignancy is attacked by cardiac tamponade, subxiphoid pericardiotomy and pericardial drainage should be performed considering neoplastic cardiac tamponade. We have described pathophysiology, diagnosis and treatment of neoplastic cardiac tamponade.