Reported on is a 72 year old man in whom a diverticulum of the lower esophagus had perforated into the pericardium causing pyopneumopericardium and cardiac tamponade during esophagoscopy. After resuscitation and drainage of the pericardial cavity the patient ameliorated and three weeks later the fistula between the esophagus and the pericardial sac had closed at least functionally as judged by a gastrografin-swallow. Planned definitive surgical closure of the fistula could not be performed because the patient's condition deteriorated following tracheobronchial aspiration. He succumbed due to bilateral pleuro-bronchopneumonia, progressive renal failure and central circulatory dysregulation. Reviewing 24 reported cases the clinical signs, etiology, differential diagnosis, therapeutic management and prognosis of this rare condition are discussed.