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Patients with pulmonary hypertension whose case is complicated by a pericardial effusion pose a management dilemma. These patients are more complex given their unique set of hemodynamics, and the decision to proceed with a pericardial fluid drainage is not straightforward and mortality is potentially high. The current medical literature does not provide strict guidelines or a formal consensus regarding this clinical presentation. It appears management should be tailored to individual cases. We present a case of a patient in whom medical management spared the risk posed by drainage.

PH Grand Rounds: When Pulmonary Arterial Hypertension Is Complicated by Pericardial Disease