Atypical clinical presentations pose a significant diagnostic challenge. We present a case that was admitted with cardiac tamponade and later diagnosed to have ruptured amoebic liver abscess. Cardiac tamponade resulted due to rupture of liver abscess into the pericardium. Our patient improved fully with pericardial drainage and medical management. This case highlights that in cases of pyopericardium coupled with fever and pain abdomen, liver abscess should strongly be suspected and ruled out.