The main aim of this study is to analyze all cases of pericardial effusions - except post cardiac procedures - who were admitted to surgical department in Al-Assad and Tichreen University Hospital in the period between 2007-2016. (63) cases of Pericardial effusions were analyzed, (38) male and (25) female, their ages were ranging between (17-67) years. The most important two causes of pericardial effusions were renal failure (50.7%) and Malignancies (34.9%). lung cancer was the leading cause of Malignancies accounting 17.4% of whole cases and 50% of Malignancies. Pericardial window via left mini thoracotomy was the preferred procedure in our study. 68.2% of the patients under went this procedure, recurrent rate was 4.6%, and the amount of recurrent pericardial effusion was minimal and didn’t need any management. Pericardiocentesis was performed in 39.6% of our patients, recurrent rate was very high 80%, therefore it was abondend as a method of treatment and its role was considered only in hemodynamically unstable patients or as a first step of preparation for pericardial window. Pericardial window via subxyhoid under local anesthesia was performed in 11.11%; recurrent rate was high 28.6%.We consider this approach only in patients who are not fit to undergo other approaches or when the expected survival is very limited. Pericardial window via thoracoscopic approach was performed in 15.8% of our patients; recurrent rate was 10% with encouraging results. During performance of pericardial window via minithoracotomy or thoracoscopically we were able to perform in (19) patients many other diagnostic and therapeutic procedures such as pleurectomy, Biopsies from the lungs, mediastinal tumors, and mediastinal lymph nodes as well. The histopathological examination of the resected pericardial window and concurrent procedures played an important diagnostic role in 23.8% of idiopathic pericardial effusions.