Computed tomography was used to guide 55 biopsies on paracardiac masses. The authors' experience, gained with over 800 thoracic biopsies, points to CT as the method of choice for paracardiac masses, especially in those cases where the masses are located close to mediastinal and cardiovascular structures, which are not easily evaluated with fluoroscopy and, therefore, imply a greater bioptic risk. Furthermore, CT allows a more accurate needle trajectory to be selected than fluoroscopic guidance does. A diagnosis was reached in 47 of 55 cases, with 85% diagnostic accuracy. No complications such as hemoptysis, hemothorax, pericarditis and hemopericardium were observed. Only one patient required drainage after pneumothorax.