T-lymphoblastic Leukemia/lymphoma presenting as pericardial tamponade: a case report and literature review

Background: T-lymphoblastic leukemia/lymphoma (T-ALL/LBL) is a rare, aggressive hematologic malignancy that typically affects young adults and often presents with a mediastinal mass or bone marrow involvement. Case presentation: A 35-year-old male with no prior medical history presented with progressive shortness of breath, dry cough, fever, night sweats, and weight loss. He was tachycardic and in respiratory distress, with jugular venous distention and muffled heart sounds. Imaging revealed a large anterior mediastinal mass with pleural and pericardial effusions. Echocardiography confirmed tamponade physiology, prompting emergent pericardiocentesis, which drained 200 ml of fluid; cytology suggested a lymphoid malignancy. Subsequent CT, PET/CT, and tissue studies confirmed T-ALL/LBL without bone marrow involvement. He began chemotherapy and was discharged in stable condition. Conclusion: Although rare, T-ALL/LBL should be considered in unexplained pericardial effusions. Key Clinical MessagePericardial tamponade may be the first manifestation of T-lymphoblastic leukemia/lymphoma. Clinicians should maintain a high index of suspicion for underlying malignancy in unexplained pericardial effusions to enable prompt diagnosis and life-saving intervention. Early multidisciplinary management is crucial to improve outcomes in such rare and aggressive presentations.