Abstract
<b><i>Introduction:</i></b> Esophageal adenocarcinoma (EAC) manifests in the glandular cells present in the lining of the esophagus and usually forms in the distal portion of the esophagus. The metastasis of EAC has been reported to occur in surrounding lymphovascular structures, the liver, brain, and bones. <b><i>Case Presentation:</i></b> We present the rare case of a 52-year-old Hispanic male with EAC metastasis to the pericardium and lungs. The patient presented with shortness of breath off and on for the last 6 weeks without any usually reported symptoms of EAC like chest pain, vomiting, or chronic cough. Respiratory examinations of this patient were significant for bilateral bronchial breathing and coarse crackles. The patient had been given numerous courses of oral antibiotics over the previous weeks with the provisional diagnosis of atypical pneumonia. Cardiac tamponade pathophysiology was also observed in this patient, for which a pericardial window was created to relieve the patient’s symptoms. A final diagnosis of EAC with an unusual metastasis in the lungs and pericardium was made based on radiological and pathological findings. The patient chose palliative care instead of curative care because of the advanced stage of this cancer. The patient received cancer diagnosis counseling and was sent to hospice care for further management. <b><i>Conclusion:</i></b> The metastasis of EAC to the pericardium and lungs instead of usual sites constitutes an important prognostic factor in the overall survival of patients.