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Malignancy associated pericardial effusion is a serious condition and testifies to poor prognosis. Cardiac tamponade can be the first presentation of underlying adenocarcinoma of the lung. We present a 78-year-old female with no known history of any malignancy, who presented with symptoms of abdominal and respiratory pathology. The physical exam findings were significant for a possible cardiac tamponade. Computed tomography (CT) of the abdomen and chest confirmed moderate bilateral pleural effusions, large pericardial effusion