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The patient not only presented with a pericardial effusion but also with a secondary pneumothorax. A bedside echocardiogram was performed quickly, and the pericardial effusion was diagnosed early. Diagnosing the pneumothorax was delayed as the chest X-ray was not expedited but the patient was treated with an intercostal catheter before complications ensued. In the context of chest pain in patients with metastatic synovial sarcoma, we argue that conducting an early bedside echocardiogram and chest X-ray is paramount to avoid potential life-threatening complications. Concurrent lung disease and recent chemotherapy administration should also raise the clinician\u2019s suspicion of pneumothorax in such cases.<\/jats:p>","DOI":"10.1136\/bcr-2022-253829","type":"journal-article","created":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T11:01:06Z","timestamp":1683025266000},"page":"e253829","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Spontaneous secondary pneumothorax with concomitant malignant pericardial effusion in the context of metastatic synovial sarcoma"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4115-7840","authenticated-orcid":false,"given":"Lewis","family":"Karapanos","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia"},{"name":"Emergency Department, Alfred Health, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Cheah","sequence":"additional","affiliation":[{"name":"Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia"},{"name":"Faculty of Medicine, Monash University, School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"2025082800334754000_16.5.e253829.1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24424"},{"key":"2025082800334754000_16.5.e253829.2","doi-asserted-by":"publisher","DOI":"10.1097\/PAT.0000000000000050"},{"key":"2025082800334754000_16.5.e253829.3","unstructured":"Kumar V , Abbas AK , Aster JC . Robbins and Cotran Pathologic Basis of Disease. Ninth ed. 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Rosen\u2019s emergency medicine: concepts and clinical practice. 7th ed. Philadelphia: Mosby\/Elsevier, 2010."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-253829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:33:56Z","timestamp":1756366436000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-253829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":12,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,2]]},"published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1136\/bcr-2022-253829"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-253829","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,5]]}}}