Objective: To report the case of a patient with renal cell carcinoma of the clear cell type with the presence of metastatic disease at diagnosis, affecting the adrenal, lung and pericardium. Evolving with cardiac tamponade and need for urgent surgical intervention, being performed through thoracoscopy, a pericardiectomy for making a pericardial window. Method: The information was obtained by reviewing the medical record, interviewing the patient, photographic record of the diagnostic methods to which the patient was submitted and literature review. Final considerations: The reported case brings to light the description of a common clinical condition in medical centers in this case, cardiac tamponade, caused by renal carcinoma of which cardiac metastatic presentation represents a low index, and the need for urgent surgical intervention as an outcome.