To evaluate the use of computed tomography (CT) in the diagnosis of pericardial heart disease, 53 patients were prospectively studied by computed tomography of the chest and cardiac ultrasound. A diagnostic-quality CT study was done for all patients; a technically satisfactory ultrasound examination was not possible in six patients. Of 47 patients in whom both chest scans and satisfactory ultrasound studies were obtained, computed tomography showed pericardial thickening not shown by ultrasound in five patients. Estimated size of pericardial effusion was the same for both computed tomography and ultrasound. Computed tomography provided quantifiable evaluation of the composition of pericardial fluid in seven patients with either hemopericardium or purulent pericarditis. Neoplastic pericardial heart disease was detected by CT scan in four of the 53 patients. Computed tomography of the chest provides a sensitive evaluation of the pericardium and quality of pericardial effusion, and is a valuable adjunct in patients in whom cardiac ultrasound is technically unsatisfactory.