A 65-year-old female presented with a 3-month history of non-exertional chest pain and breathlessness. She was referred to cardiology. A CXR was performed (Image 1). An echocardiogram was arranged and a large pericardial effusion was found. This was drained and a sample sent to microbiology, none was sent for cytology. There was no growth from the sample. After a period of 6 months, a follow-up CXR (Image 2) was performed which generated a CT (Images 3a, b) of the thorax.