Cardiac tamponade as the first clinical manifestation of metastatic adenocarcinoma of the lung

A 62-year-old woman presented in the emergency department with new onset of dyspnea and clinical signs of cardiac tamponade. She had a history of ciga rette smoking and a family history of adenocarcinoma, pancreatic and boast carcinoma. An emergency two-dimensional echocardiogram confirmed the diagno sis of cardiac tamponade. Therapeutic pericardiocentesis resulted in prompt relief. Cytology confirmed malignant glandular cells, consistent with a me tastatic adenocarcinoma. Computerized chest tomography confirmed pulmonary involvement.