Description 

A 74-year-old Japanese woman with no remarkable medical history reported lower extremity oedema for 4 months before visiting our hospital. She presented with breathing difficulty at admission and subsequently reported coughing and paroxysmal nocturnal dyspnoea 1 month prior to admission. Chest radiography revealed cardiac dilation and bilateral pleural effusion. Chest and abdominal CT and PET revealed nodules and enlargement of the right paratracheal lymph node in the right lung, abdominal lymphadenopathy, and pericardial and pleural accumulations of fluid. Adenocarcinoma was detected during pleural effusion examination. The patient was diagnosed with cT2aN3M1b stage IV pulmonary primary adenocarcinoma following a bronchoscopic examination. Cardiac tamponade was suspected based on a systolic blood pressure of 90 mm Hg, pulse of 120 bpm and oxygen saturation of 90% on room air; therefore, a cardiac puncture without continuous suction was performed. Following puncture, the radiolucent pockets representing …