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A 38-year-old man who was admitted with peptic ulcer developed sudden onset dyspnoea and chest pain associated with hypotension and tachypnoea. Precordial examination showed faint heart sound with succussion splash and metallic tinkling sounds. Chest radiography showed evidence of pneumopericardium (panel A); however, echocardiography was normal. A day later, his breathlessness worsened …
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