Pericardial effusion describes accumulation of fluid in the pericardial space. When it happens with malignancy, it incurs poor prognosis. Most often lung, hematological or breast carcinomas form the background. It may cause hemodynamic instability and cardiac tamponade and require prompt invasive management. This is elaborated by this article. This is a case report of 55 year old Asian man who presented with a month history of lethargy fever, sweating and worsening dyspnea. He was assessed in the Triage room and some imaging was performed. Pericardial effusion was found and emergency pericardiocentesis performed. The patient was managed through multidisciplinary approach. It is, thus, recommended to set a low threshold for diagnosis and management for pericardial effusion.