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The pericardium is a tough, double-layered fibrous sac that encloses the heart and great vessels (see Images. Midline Thoracic Anatomy, Sagittal View; Anatomical Relations of the Superior Mediastinum and Diaphragm). The structure keeps the heart in a stable position within the mediastinum, facilitates cardiac movements, and separates the heart from the lungs and other mediastinal structures. The pericardium also contributes to physiological cardiac function.[1][2][3] Knowledge of pericardial anatomy and function enables clinicians to identify and manage conditions such as pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis by understanding fluid dynamics, chamber constraints, and pressure-volume relationships. Surgical interventions, including pericardial incisions and pericardiocentesis, require precise anatomical awareness to avoid injury to the heart, great vessels, phrenic nerves, and surrounding structures. Understanding pericardial reflections, sinuses, and attachments guides safe access for catheter-based procedures, interpretation of imaging, and management of postsurgical complications.