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A 42-year-old man without a past cardiovascular history arrived in the emergency department reporting progressive chest pain, abdominal discomfort, dyspnea at rest, and orthopnea of 4 days duration. An abdominal ultrasound revealed significant pericardial and bilateral pleural effusion, with hepatomegaly and ascites of a probable congestive nature. A transthoracic echocardiogram showed severe pericardial effusion with data of hemodynamic compromise, and a right retroauricular mass anchored to the posterior atrial wall (Figures 1A and 2; Movies I and II in the online-only Data Supplement). Figure 1. A , Apical 4-chamber view transthoracic echocardiogram showing concentric severe pericardial effusion (PE), right (RV) and left (LV) ventricle, and tumor (arrow). B , CT scan showing tumor mass (arrow) attached to the right atrium (RA). C , Apical 4-chamber view with color flow Doppler demonstrating in the right chambers flow acceleration (arrow) secondary to extrinsic tumor compression. D , CT scan …