Case number PHHY2015US021272, is an initial literature case report received on 18 Feb 2015. The author in the article discussed about the adenocarcinoma of the lung presenting as tamponade. This report refers to a 45-year-old male patient. The patient was a former smoker. No concomitant medication was reported. He was vaccinated with influenza vaccine (manufacturer unknown, batch number: not reported) on an unknown date. Two days after vaccination, the patient complained of weakness and dyspnea on exertion for one week. The patient had first noticed these symptoms while hiking with his family and attributed them to the vaccine. Further, at work the patient had increased short of breath and the patient went to emergency room. On examination, the patient was anxious without acute distress. The patient's blood pressure was 102/71 (units not reported) pulse was 120 (units not reported), respiration was 23 (units not reported) and oxygen saturation 96 % on room air. The patient's neck veins were not distended. Chest examination was clear bilaterally with decreased sounds at the right base. Cardiovascular examination noted tachycardia, regular rhythm and distant heart sounds. The remainder of the examination was unremarkable. Electrocardiogram (EKG) demonstrated sinus tachycardia and electrical alternans. Chest radiograph showed an enlarged cardiac shadow. Computerised tomogram (CT) scan of the chest showed a large pericardial effusion and bilateral pleural effusions. A bedside echo demonstrated a large pericardial effusion with tamponade physiology. The patient underwent emergent pericardiocentesis with catheter placement and pericardial window. Cytology of the fluid revealed adenocarcinoma with staining positive for CK7, CEA, Napsin and TTF-1 consistent with lung origin. Subsequent supraclavicular node biopsy confirmed metastatic adenocarcinoma of a lung primary. As an outpatient, he had a positron emission tomogram (PET) CT and magnetic resonance imaging (MRI). PET scan was significant for a FDG avid nodule in the right middle lobe consistent with primary lung carcinoma with extensive spread to the abdomen. MRI of the brain had no evidence of metastatic disease. The final outcome of the events was not reported. Seriousness of the events was not reported. The event "metastatic adenocarcinoma of lung primary with extensive spread to the abdomen" was upgraded based on NVS-IME list and the events "supraclavicular node biopsy confirmed metastatic adenocarcinoma of a lung primary, metastatic adenocarcinoma of lung primary with extensive spread to the abdomen and anxiety" were upgraded based on the information available in the source document. The author concluded that the occurrence of tamponade as the presenting manifestation of an extra cardiac malignancy was rare. In patients presenting with pericardial effusion pericardiocentesis was vital to provide relief of symptoms and determine the etiology of the fluid especially in those with risk factors for malignancy. Cytological examination of the fluid with flow cytometry provides an immediate and accurate means of diagnosis. In general pericardial effusion in the setting of primary lung cancer tends to be indicative of rapid tumor progression and shorter survival.