We reviewed 36 cases of symptomatic malignant pericardial effusion managed with pericardiocentesis at our institution from 1982 to 1989. There were 13 men and 23 women, aged 49 ± 12 years (range, 33–76 years). The commonest underlying tumours were lung cancer (12 cases, 33%) and breast cancer (11 cases, 30%). Pericardiocentesis was successful as the initial management in 34 of 36 patients (94%); one patient died as a result of the procedure and another required subxiphoid incision and tube drainage of the effusion. When intrapericardial sclerotherapy was performed, only three of 28 patients required repeat pericardiocentesls, and when sclerotherapy was not performed Initially, four of seven patients had recurrent symptomatic effusions. Median survival following pericardiocentesis in breast cancer patients was 10 months (range, 0–36 months) and in all other malignancies was four months (range, 0–12 months). We conclude that perlcardlocentesis with intrapericardial sclerotherapy provides good local control for symptomatic malignant pericardlal effusion in the majority of patients. In spite of this, the median survival of such patients is poor, especially in patients with malignancies other than breast cancer, with few patients surviving more than a few months.(Med J Aust 1991; 154: 19–22) Received 1 Jun 1990 Accepted 6 Aug 1990