A 60-year-old smoker presents with breathlessness for 2 weeks. On examination: hea rate is 100/min, BP = 90/60 mm Hg and neck veins are distended with a palpable liver. CXR is shown. What is the probable diagnosis?

* Since in the CXR, the cardiac borders look bulging and CT ratio is increased, the finding is that of a water bottle hea/ money bag appearance. In clinical setting of hypotension with distended neck veins, this patient is having a massive pericardial effusion and developing findings of a tamponade. * The point against cor pulmonale is that it is characterized by right ventricular failure with pulmonary aery hypeension. But in this CXR, pulmonary aery segment is not bulging.