Pericardial cysts are rare, benign, congenital anomalies. Most are asymptomatic and are found incidentally on chest radiographs. Some may cause symptoms and complications. Giant pericardial cysts are even more rare, and few reports on their natural history, presentation and management are available. This report describes a giant pericardial cyst that exerted pressure on the heart and lungs and was excised surgically. Subsequently, the patient has been asymptomatic for nine years and appears to be in complete remission.