A 55-year-old previously healthy male with dyspnea. (a) Chest radiograph shows an enlarged cardiac silhouette, a right pleural effusion, and dilated azygos vein (arrow), (b) CECT demonstrates extensive venous collaterals around the heart, including prominent filling of (b) subcutaneous, (c) inferior phrenic, and (d) hepatic veins. (e) CECT shows a large pericardial effusion. The interventricular septum is flattened. The constellation of effusion, flat septum, and impaired venous return (b–d) is consistent with tamponade physiology. The patient’s symptoms and blood pressure improved after pericardiocentesis. Fluid cytology was positive for malignant cells. He was later diagnosed with nonsmall cell lung cancer.
