Pericardial effusion is a relatively common clinical problem. It is, however, rarely the first symptom of cancer. Cardiac tamponade testifies to an advanced stage of cancer and is a negative prognostic factor. This paper presents a patient in whom cardiac tamponade was the first symptom of lung cancer. A 63-year-old male, habitual smoker, was admitted to hospital due to progressive symptoms of exertional dyspnoea lasting for a few days and chest pain. Echocardiographic examination revealed a large amount of fluid in the pericardium with echocardiographic signs of a life-threatening cardiac tamponade. The patient underwent pericardial puncture and additional imaging examinations. Lung adenocarcinoma was recognized as the underlying disease. Due to the recurrence of the life-threatening cardiac tamponade, video-assisted thoracoscopic pericardial fenestration was performed and systemic chemotherapy was introduced with good results.
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