Cardiomegaly is a commonly encountered clinical presentation on simple chest radiographs, and it usually indicates theenlargement of one or more cardiac chambers. However, cardiomegaly less commonly comes from abnormalities in the structuresadjacent to the heart, including pericardial effusion, enlarged great vessels, or mediastinal tumors. Pericardial lipoma is a rareprimary cardiac tumor that can grow to a large size by the time of diagnosis and result in huge cardiomegaly because of a lack ofsymptoms. Here, we report a rare case of giant pericardial lipoma that presented as huge cardiomegaly on simple chest radiographs. Multi-modality cardiovascular imaging, including echocardiography and cardiac magnetic resonance imaging, played a key role inthe diagnosis and development of a therapeutic treatment plan for the present case.