The development of cardiac tamponade as the presenting feature of neoplastic disease is extremely uncommon. We report three patients with lung adenocarcinoma clinically presenting as cardiac tamponade. The diagnosis was made by the cytological study of pericardial fluid in all three. To update the clinical aspects of this uncommon association we have reviewed the literature and we have found 52 additional patients with different types of neoplasia who presented as cardiac tamponade.