Between the devil and the deep blue sea: an unusual kind of late cardiac tamponade with a therapeutic dilemma.

A 67-year-old patient underwent a left pneumectomy because of a moderately differentiated squamous cell carcinoma. Two weeks later, while still in hospital, he suddenly experienced an acute increase in dyspnoea. Pulmonary embolism was considered. However, echocardiography showed compression of the right ventricle and right atrium by an intrapericardial mass, confirmed by computed tomography. Following signs of a large thrombus in the inferior vena cava, pericardiocentesis was considered undesirable due to possible dislocation resulting from the sudden changes in intrapericardial pressure. Re-thoracotomy was equally undesirable because of the recent operation and status of the patient. After stabilisation and extensive consulting the patient was referred for pericardiocentesis by sternotomy. Huge blood clots were removed from the pericardial space. No thrombus mass was found in the inferior vena cava. The patient recovered uneventfully.