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To the Editor No account of idiopathic large pericardial effusions1 would be complete without mention of the requirement to rule out IgG4-related disease (IgG4-RD) as a possible underlying cause.2 3 IgG4-RD was the underlying cause of cardiac tamponade in a 60-year-old woman in whom pericardiocentesis yielded 635 mL of pericardial fluid. Chest CT also showed ‘significant’ pericardial thickening. Pericardial biopsy showed massive infiltration by lymphocytes and IgG4-positive plasma cells. Following …
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