Cardiac tamponade as the initial presentation of metastatic lung adenocarcinoma with high PD-L1 expression

Introduction: Cardiac tamponade secondary to lung cancer is an oncologic emergency with a major impact on treatment strategy and patient prognosis. Case presentation: A 54-year-old active smoker presented with cardiac tamponade requiring admission to the intensive care unit. Diagnostic and therapeutic pericardiocentesis confirmed lung adenocarcinoma. Staging studies revealed nodal involvement and bone metastases. The tumor showed a PD-L1 expression of 70%, with no actionable genomic alterations identified. During the clinical course, the patient developed bilateral pulmonary embolism. Following clinical stabilization and given the aggressive nature of the disease, first-line chemoimmunotherapy was initiated, resulting in rapid clinical improvement and sustained disease stabilization throughout follow-up. Discussion: In patients with a high tumor burden and life-threatening disease, chemoimmunotherapy, rather than immunotherapy alone, may provide superior symptom control and improve survival outcomes. Conclusion: Individualized intensive systemic therapy can achieve disease control even in patients presenting with highly aggressive disease.