Noninvasive imaging has profoundly altered our ability to diagnose and manage patients with suspected pericardial disease. Although pericardial involvement may first become apparent on a chest radiography, echocardiography (M-mode, 2-D, and Doppler) is the procedure of choice for identifying and characterizing pericardial disease. CT and MRI frequently provide complementary information and in certain instances are necessary for diagnosis. Studies that compare diagnostic accuracy in subsets of patients with pericardial disease are clearly needed, but availability, safety, and cost considerations will influence the choice of procedure. Regardless of the imaging study selected, it is imperative that the results be interpreted in the context of the clinical examination.