Purulent pericarditis (PP) is a very infrequent entity, and its finding generally implies infection in an adjacent or distant foci. Another possible cause not implying the existence of an associated infectious process is the presence of an esophago-pericardial fistula. The case of a patient with a neoplasm of the esophagus is described in which the form of presentation of the disease was cardiac tamponade by PP. Revision of the literature identified only one other case of PP secondary to an esophago-pericardial fistula of malignant origin.