Patient History: A 42-year-old man complains of 2 days of worsening chest pain and dyspnea. Six weeks ago, he was diagnosed with non-Hodgkin lymphoma with lymphadenopathy of the mediastinum, and he has been treated with mediastinal radiation therapy. His most recent treatment was 1 week ago. He has no other medical or surgical history and takes no medications. Physical Examination: His chest pain is constant and unrelated to activity. He becomes short of breath with minimal exertion.
He is afebrile, heart rate 115 bpm with a thready pulse, respiratory rate 22 breaths per minute, and blood pressure 108/86 mm Hg. Systolic blood pressure drops to 86 mm Hg on inspiration. He appears uncomfortable and is diaphoretic. His jugular veins are distended to the angle of the jaw, and his chest is clear to auscultation. He is tachycardic, his heart sounds are faint, and no extra sounds are…
