Pericardial cysts are rare mediastinal cysts having congenital origin or develop secondary to pericarditis, trauma, or infection. Although most pericardial cysts are asymptomatic, lifethreatening complications can occasionally occur. We report on a 43-year-old female with an asymptomatic 5.5x6.0x6.3 cm pericardial cyst that was incidentally found as an abnormal cardiac silhouette on routine chest radiography. Further imaging confirmed the presence of a pericardial cyst that was compressing the right atrium and ascending aorta. The patient underwent successful thoracoscopic removal of the pericardial cyst under general anesthesia. The patient’s postoperative course was uneventful and he was discharged on postoperative day 4 in a stable condition. Knowledge regarding the perioperative challenges associated with the removal of pericardial cysts can prevent complications and improve patient outcomes.