Beck described a triad of hypotension, muffled heart sounds, and elevated jugular venous pressure due to cardiac tamponade from pericardial effusion. Immediate pericardiocentesis is life-saving. The common causes of pericardial effusion include malignancy, congestive heart failure, tuberculosis, systemic lupus erythe-matosus, Dressler's syndrome, and uremia. This CXR shows a globular enlargement of the heart, typical of a large pericardial effusion. In addition, there is a mass in the right lung in keeping with the primary lung cancer.
Case 21. This 65-year-old male had a long history of dyspnea on exertion, orthopnea, and bilateral ankle edema. This was his CXR (Fig. 21.1). Should a thoracocentesis be done?
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