Spontaneous secondary pneumothorax with concomitant malignant pericardial effusion in the context of metastatic synovial sarcoma

Synovial sarcoma is a rare malignancy that commonly metastasises to the lungs, lymph nodes and more infrequently to the heart. It is associated with an elevated risk of pneumothorax. In this case, we report a case of dual pathology in a metastatic synovial sarcoma patient. 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’s suspicion of pneumothorax in such cases.