BACKGROUND: Pericardial tumours are unusual and may be difficult to characterise with imaging. They manifest as large, non-contractile, solid masses within the pericardium. Presenting symptoms include heart failure, arrythmias, sudden death, cyanosis and chest pain. CASE PRESENTATION: We describe a case of massive pericardial fibroma in a 52 year old woman, who presented with palpitations only. CONCLUSION: We illustrate the different imaging modalities available to image this tumour prior to surgical resection, and indicate the strengths and weaknesses of each.