Malignant esophageal diseases can cause esophagopericardial fistulas. This is a rare complication associated with an extremely high mortality rate. Covered self-expanding metal stents have been considered as the treatment of choice for palliation of malignant esophageal obstructions and for malignant esophago-respiratory fistulas. Leakage of food and secretion into the pericardium is life-threatening; in addition, patients are typically unable to eat due to esophageal obstruction. Few data exist for the optimal treatment of malignant esophagopericardial fistula. We describe a rare case of esophageal squamous cell carcinoma complicated by an esophagopericardial fistula presenting as cardiac tamponade. After placement of a covered self-expanding esophageal metal stent, along with aggressive antibiotic therapy and pericardial drainage, the patient was able to resume oral intake and was later discharged from the hospital to hospice care. The patient survived 5 weeks, which is longer than similar cases documented in the English literature.