Massive pericardial effusion in sarcoidosis is rare. We summarize the features of a recent patient along with a review of 9 previously reported cases. All but 1 patient with massive pericardial effusion were female and all had massive cardiomegaly on their chest roentgenogram with 7 of the 10 also showing features suggestive of sarcoidosis (bilateral hilar adenopathy with or without interstitial infiltrates). Nine of the 10 patients required a drainage procedure (pericardiectomy or pericardiocentesis). Pericardial histology revealed noncaseating granulomas in 6 of 7 patients. Two of the patients expired within the first week of hospitalization with evidence of myocardial involvement. The remainder of the patients have had clinical stability most responding to steroids, yet recurrences were seen in 3 patients and 1 patient required cyclophos-phamide for control.