Pericardial fluid cytology should be used judiciously for cases where there is a strong clinical suspicion for malignancy. A thorough morphological assessment with adequate clinical information and correlation with other investigations can be used to arrive at a definitive diagnosis in most cases. Pericardial fluid tapping is mostly done through the xiphisternum approach under full aseptic conditions and under the continuous constant monitoring of ECG (Lead II) to ensure patient safety and accurate procedural guidance.