Pericardial cysts are an uncommon cause of mediastinal masses and may be found incidentally on imaging. Symptoms commonly include cough, chest pain, and shortness of breath elucidating a broad differential on examination. Diagnosis is predominantly made using imaging modalities, such as CT, MRI, and CXR with treatment including resection for symptomatic cysts and observation for asymptomatic cysts. Due to a lack of specific signs and symptoms towards identifying pericardial cysts, many are identified at a later stage requiring resection by video-assisted thoracoscopic surgery (VATS). We present the rare case of a patient presenting with a sudden onset cough, shortness of breath, and pleuritic chest pain found to have a large pericardial cyst.