Patients with malignant pericardial tamponade have a poorer prognosis than patients with non malignant effusion in a neoplastic context. Pericardial metastases occur frequently in advanced-stage disease patients, in 5-10% of all patients with cancer. Among a personal series of five patients who underwent the same procedure, we report characteristic imaging features of a 16-year-old man presenting with malignant tamponade, who was successfully treated by percutaneous pericardioperitoneal shunt. Percutaneous balloon pericardiotomy is a well-tolerated, safe, and well-known technique, but little has been described concerning imaging the percutaneous pericardioperitoneal shunt. This life-saving procedure should be used for recurrence of malignant tamponade and should also be considered for initial treatment. Advantages of the percutaneous procedure include minimal discomfort, low morbidity rate, and efficiency similar to surgical pericardiotomy without sedation.