Incidental pericardial abnormalities are commonly encountered in routine chest computed tomography scans, ranging from asymptomatic or benign lesions to life-threatening findings that may require prompt and urgent management. Therefore, radiologists must be familiar with the key CT imaging findings to diagnose these pericardial pathologies. This chapter discusses the potential role of routine non-gated chest computed tomography for diagnosing and managing pericardial diseases including pericardial effusions, cardiac tamponade, pericarditis, epipericardial fat tissues and absent pericardium.