The imaging features of intrapericardial paragangliomas (pheochromocytomas) are described. We conducted a retrospective study of the imaging features of all intrapericardial paragangliomas seen at our institution over the last 13 years. In this study, intrapericardial paragangliomas were typically located adjacent to or involved the left atrium. The diameter of the tumors ranged from 3 to 8 cm. Metaiodobenzylguanidine (MIBG) scintigraphy revealed 11 of 12 tumors (sensitivity = 92%). After MIBG scintigraphic location, dynamic contrast-enhanced CT revealed all 12 tumors. Intrapericardial paragangliomas are rare tumors, typically located adjacent to or involving the left atrium. For initial detection, regional location of these extraadrenal tumors, and detection of distant metastases, MIBG scintigraphy is recommended. Dynamic contrast-enhanced CT or MR imaging can then provide detailed anatomic delineation before surgical resection.