T-cell Acute Lymphoblastic Leukemia Presenting as a Cardiac Tamponade

Acute leukemia presenting as a clinically significant pericardial effusion or cardiac tamponade is a rare event. We report the case of a young man who presented to the emergency department with symptoms of dyspnea and hemoptysis and was found to have a cardiac tamponade as the presenting sign of a hematologic malignancy. The patient underwent a therapeutic pericardiocentesis which showed presence of lymphoblasts. A bone marrow aspiration and phenotype analysis confirmed the diagnosis of T-cell acute lymphoblastic leukemia. He was started on chemotherapy without immediate complications. Additionally, we briefly describe the approach to diagnosing pericardial effusions in complex emergency presentations by raising clinical suspicion and identifying suggestive signs on the different tests available to the emergency physician.