An unusual cause of dysphagia

A healthy 79-year-old woman presented with cachexia, progressive dysphagia and dyspnoea (New York Heart Association Class III) over 4 weeks. (A and B) Chest X-ray. (C) Echocardiogram. (D) After drainage through the right fifth intercostal space and creating a pericardopleural window, symptoms resolved completely. Extensive workup did not show any aetiology. Very rarely, dysphagia can be a sign of a pericardial disease.