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Pericardial diseases comprise a heterogeneous spectrum, ranging from self-limited acute pericarditis to recurrent inflammatory syndromes, large pericardial effusions, cardiac tamponade, and chronic constrictive pericarditis. Although acute pericarditis is often considered a benign condition, a substantial proportion of patients develop recurrent or persistent disease with prolonged symptoms and an impaired quality of life. Diagnostic uncertainty and suboptimal early management, particularly excessive corticosteroid use, may further contribute to the development of chronic disease and treatment resistance. Recent advances in cardiovascular imaging and anti-inflammatory therapy have substantially transformed the management of pericardial diseases. Multimodality imaging, including echocardiography, cardiac computed tomography (CT), and cardiac magnetic resonance (CMR) imaging, plays a central role in anatomical assessment, evaluation of hemodynamic impact, and differentiation of active inflammation from irreversible fibrotic remodeling. Meanwhile, an improved understanding of the autoinflammatory pathways involved in recurrent pericarditis has led to the development of targeted therapies, most notably interleukin -1 (IL-1) inhibitors, which have demonstrated robust efficacy and meaningful steroid-sparing effects in refractory disease. This review summarizes contemporary diagnostic and therapeutic strategies for pericardial diseases, with an emphasis on recurrent pericarditis and imaging-guided management. We propose a stepwise, precision-based approach that integrates clinical risk stratification, multimodality imaging, and targeted anti-inflammatory therapy to optimize patient outcomes.