Massive pericardial effusion is rarely the sole clinical presenting symptom of sarcoidosis. Herein we report a case of recurrent pericardial effusions requiring surgical intervention secondary to sarcoidosis. A review of the literature regarding the prevalence/histopathology, the role of endomyocardial biopsy, the use of cardiac magnetic resonance imaging, and the utility of steroid based treatments in the management of cardiac sarcoidosis is discussed.