Pericardial drainage is an important diagnostic and therapeutic option in the symptomatic patient with large amount of pericardial effusion (PE). However, when the amount of PE is relatively small, physicians are often reluctant to perform the invasive drainage of the fluid due to the increased risk of causing myocardial injury during the procedure. Even in some cases of suspected pericarditis with small amount PE, an initial empirical anti-inflammatory therapy is often recommended. A 65-year-old woman presented with mild dyspnea for two weeks. The echocardiography revealed small amount of PE. A careful fluoroscopy-guided pericardiocentesis, subsequent pericardial fluid cytology, and thorough whole body check-up demonstrated adenocarcinoma with no proven primary site. After the palliative chemotherapy, she had survived for 15 months until her death due to asphyxia. Although pericardiocentesis is considered dangerous in small amount of PE, a prompt and careful drainage may provide early detection of hidden malignancy and better survival outcome.

Hypothyroidism may accompany pericardial may accompany pericardial effusion occasionally, in the patient who complains of any symptom of hypothyroidism and dose not receive treatment. We have experienced two cases of hypothyroidism presenting with the symptoms of dyspnea and chest tightness. The cuase of dyspnea and chest tightness was pericardial effusion and congestive heart failure. So we report two cases of primary hypothyroidism presenting with pericardial effusion and review the literature.