Malignant pericardial effusion as initial solitary site of metastasis from transitional cell carcinoma of the bladder

A patient is presented whose first and sole evidence of metastatic transitional cell carcinoma of the bladder was pericardial metastasis with life-threatening cardiac tamponade. Definitive diagnosis and management was achieved with fluid cytology and video-assisted thoracic surgical pericardial biopsy and pericardial window.