A 73-year-old woman without a history of cardiovascular disease was admitted to the hospital with progressive dyspnoea on exertion during the past several weeks, bilateral lower extremity oedema, orthopnoea and paroxistic nocturnal dyspnoea. She lived a few metres away from a badly preserved building containing asbestos for 50 years. Estimated jugular venous pressure was 6+5 cm H2O, a pericardial friction rub was heard, bilateral basal lung crackles were present and symmetrical below-knee pitting oedema was seen. Probrain natriuretic peptide was 2304?pg/mL, and chest radiograph showed a globular cardiac silhouette and blunting of the costophrenic angles due to a small transudative pleural effusion containing benign mesothelial cells on cytological analysis. Transthoracic echocardiogram showed a large pericardial effusion with diastolic collapse of the right ventricle and a hypotransparent mass (4×1.6?cm) attached to the visceral pericardium in the right apex (video 1). Therapeutic pericardiocentesis was performed and cytological analysis of pericardial fluid demonstrated malignant cells of inconclusive origin. CT scan of the chest, abdomen and pelvis, mammography and upper and lower gastrointestinal endoscopies showed no evidence of extracardiac disease. A primary cardiac tumour was assumed and positron emission tomography-CT was done, as a part of the staging workup, demonstrating isolated hyperfixation in the apex and right atrium.
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