A rare presentation of extragonadal germ cell tumor; massive pericardial effusion with impending tamponade

The clinical manifestations of extragonadal germ cell tumor (EGGCT) depend on its location and are often caused by compression on surrounding structures. Pericardial effusion is absolutely rare as an initial clinical manifestation for this tumor. We report a 31-year-old man presenting to the emergency department with dyspnea. Two-dimensional echocardiography revealed a massive pericardial effusion with impending tamponade. The patient was immediately transferred to the operating room where a cardiac surgeon drained bloody effusion. A mediastinal mass measuring 173×105×105 mm was accidentally noticed during COVID-19 work-up. Fine core needle biopsy of the mass led to the diagnosis of a germ cell tumor, which was treated appropriately. This study shows the importance of proper work-up in pericardial effusion cases with chest CT-scan as an important part of it.