{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:58:54Z","timestamp":1785383934740,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology Case Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Metastatic gastric adenocarcinoma rarely manifests initially with massive pleuropericardial effusions and life\u2010threatening cardiac tamponade. Identifying the primary tumour source in such acute and complex clinical presentations represents a significant diagnostic challenge. A 44\u2010year\u2010old man with a history of heavy tobacco smoking and chronic opium use presented with acute\u2010onset dyspnea and chest pain. Imaging revealed massive pleural and pericardial effusions causing cardiac tamponade, necessitating urgent pericardial drainage. Initial investigations, including pleural and pericardial fluid analyses, were non\u2010diagnostic and demonstrated lymphocyte\u2010predominant exudative effusions. Definitive diagnosis was achieved through video\u2010assisted thoracoscopic surgery (VATS) with pleural biopsy, revealing metastatic adenocarcinoma. Immunohistochemical profiling (CK7+\/CK20+\/TTF\u20101\u2212) supported a primary origin of gastric carcinoma. The patient's clinical course was complicated by ventilator\u2010associated pneumonia and septic shock, ultimately resulting in death before initiation of systemic therapy. This case highlights the diagnostic challenge of occult gastric adenocarcinoma presenting with pleuropericardial effusions and tamponade. In unexplained lymphocyte\u2010predominant effusions, malignancy should be considered, and early VATS\u2010guided pleural biopsy may be required when noninvasive tests are inconclusive. Prognosis remains poor in advanced disease.<\/jats:p>","DOI":"10.1002\/rcr2.70676","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:19:42Z","timestamp":1783556382000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Metastatic Gastric Adenocarcinoma Presenting With Pleuropericardial Effusions and Cardiac Tamponade: A Diagnostic Challenging Case Report"],"prefix":"10.1002","volume":"14","author":[{"given":"Mahta","family":"Moradi","sequence":"first","affiliation":[{"name":"School of Medicine Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4388-0214","authenticated-orcid":false,"given":"Mehdi","family":"Karimi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Bogomolets National Medical University  Kyiv Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pegah","family":"Babaheidarian","sequence":"additional","affiliation":[{"name":"Department of Pathology, School of Medicine Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed Arash Javad","family":"Moosavi","sequence":"additional","affiliation":[{"name":"Research Center Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Nakhaie","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Rasool Akram Hospital Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Ghaderi","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Rasool Akram Hospital Iran University of Medical Sciences  Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.935434"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jasc.2024.12.005"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1468488"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.10740"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf192"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-013-1488-z"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-025-01638-x"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24032895"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41021-025-00328-w"},{"issue":"2","key":"e_1_2_8_12_1","first-page":"104","article-title":"Opium Use and Gastrointestinal Cancers: A Systematic Review and Meta\u2010Analysis Study","volume":"17","author":"Mohammadi M.","year":"2024","journal-title":"Gastroenterology and Hepatology From Bed to Bench"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2022-219784"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/jor4010004"}],"container-title":["Respirology Case 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