Pneumopericardium is a rare disease defined by the presence of gas in the pericardial sac, which can be caused by tuberculous constrictive pericarditis and pericardiocentesis. A 23-year-old male was admitted with a chief complaint of intermittent chest pain and severe shortness of breath. Tamponade was first diagnosed and pericardiocentesis was done. Massive pericardial effusion might be due to tuberculous infection (endemic area). Follow-up using chest computerized tomography (CT) after pericardiocentesis showed pneumopericardium. Pneumopericardium can be caused by tuberculous pericarditis and direct injury secondary to pericardiocentesis. This case report highlights the importance of using imaging modalities to detect this disease and provide a new recommendation of treatment for these patients.