A 54-year-old man with lung cancer being treated with chemotherapy presents with progressive fatigue, peripheral edema, and lightheadedness. Although the symptoms were felt to be related to the lung tumor, a chest x-ray was obtained, which showed a markedly increased cardiac silhouette. There was no evidence of vascular congestion. A lung tumor in the left upper lobe was observed. An echocardiogram confirmed a significant pericardial effusion with evidence of tamponade. On physical examination, he had significant peripheral edema and neck vein distension. A pulsus paradoxus of 18 mm Hg was noted.
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