**2. Reasons requiring surgical drainage**

#### **2.1 Neoplastic**

The common etiologies encountered in surgery for pericardial effusion can be broadly classified into neoplastic, infective, and reactive. For neoplastic causes, frequently malignant pericardial effusion can manifest after tumor involvement of the pericardium. Majority of this type of effusion will be from hematogenous

spread, whereby primary tumors of the pericardium are rare [1]. Occasionally, pericardium effusions can result from local spread of thymic malignancy and even myocardial tumor-like lymphoma. We will discuss the rationale for proceeding with therapeutic surgical drainage for this group of patients later, as this involves a careful consideration of their long-term prognosis.
