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A 27-year-old woman presented with progressive dyspnoea, orthopnoea, left-sided pleuritic chest pain (improved on upright posture), 20 mm of pulsus paradoxus, distant heart sounds, and impending pericardial tamponade (confirmed on two-dimensional echocardiogram). One litre of bloody fluid was removed by pericardiocentesis.
A two-dimensional Doppler echocardiogram and transoesophageal echocardiogram demonstrated …