The chest and abdominal CT showed lowdensity lesion in the right liver with blurred margin. The severe pleuraleffusion suspect malignancy related and we check tumor makers for survey. Theabnormal tumor makers(CA-199>12000, CEA:95.95, PSA:4.032) was found and weconsulted Oncology.We also arrange liver MRI for suspect cancer survey. Theliver MRI showed consider hemangiomas in both lobes of liver. The pleural andpericardial effusion cyctology reports showed consistent with metastaticpulmonary adenocarcinoma so we consulted Oncology and CS.The CS suggest arrangeVATS Pericardial window creation & bilateral pleurodesis and send EGFR & ALKtest but patient refused so we sned fluid cytology cell block. The cardiac echoshowed s/p CVC catheter inserted, clamp for 1 day, minimum pericardial effusionlarge pleural effusion with mass-like lesion (6.62*3.92 cm ), suspect contact toinferolateral epicardium. With stable condition and symptoms, he will transferto ward for further therapy.