The timing and method of drainage ultimately depends on the etiology of effusion, acuity level of patients, and availability of trained physicians. Percutaneous drainage provides a rapid, minimal preparation and less procedural mobidity.4,5,18 On the other hand, surgical drainage by the creation of a pericardial window by an open surgery or a video-assisted thoracic approach allows complete drainage and permits the direct examination of the pericardium with access to the pericardial tissues for histopathology and microbiologic diagnosis. Percutaneous balloon pericardiotomy, described by Palacios et al.,33 involves the use of a percutaneous balloon-dilating catheter to form a pericardial window to initially facilitate the malignant effusion drainage. Further studies and clinical report showed substantial success in pediatric population and non-neoplastic disease spectrum.31 Balloon pericariodotomy appears to be a valid procedure to shorten surgical morbidity and concomitant anesthesia burden in part, and therefore should be considered upon institutional availability giving the low complication rates, similar to treatment by simple drainage