A 41-year-old man with chronic hepatitis C and cirrhosis presented with pericardial effusion and tamponade requiring pericardiocentesis. Nine liters of pericardial fluid was drained with complete resolution of his ascites. He represented with recurrent pericardial effusions despite salt restriction and diuretic therapy. Subsequent radionuclide scans demonstrated a direct connection between the peritoneal and pericardial spaces. A pericardial window was formed but despite this there was recurrence of pericardial effusion and pleural effusion. The patient underwent orthotopic liver transplantation 7 months later and no recurrence of pleural or pericardial effusion was observed following transplantation. We believe this is the first case report of pericardial effusion secondary to cirrhotic ascites and a communication between the peritoneal and pericardial cavities.