Here, we present a case of recurrent chronic massive pericardial effusion without the development of tamponade. The patient was diagnosed with idiopathic chronic massive pericardial effusion, with a history of pericardiocentesis every five years, and no etiology was found. Emergency pericardiocentesis was not considered because the vital signs of the patient who was admitted with the complaint of shortness of breath were stable at the time of admission. However, the patient with simultaneous carbon dioxide retention was connected to a non-invasive mechanical ventilator for treatment. Hypotension and tachycardia developed rapidly. This case, the largest pericardial effusion (16 cm) in the literature, demonstrates the critical importance of pericardial space elastic flexibility on the hemodynamic profile. In addition, mechanical ventilation administration in a patient with pericardial effusion can quickly disrupt the clinic and be fatal. Therefore, pericardiocentesis should be performed first.

Keywords: massive pericardial effusion, pericardiocentesis, non-invasive mechanical ventilator, hemodynamic.