A 45-year-old male from a rural area in sub-Saharan Africa presents to the clinic with a 2-week history of progressive shortness of breath, fatigue, and a sensation of fullness in his chest. He reports that the symptoms have gradually worsened, particularly when lying flat, and he has noticed swelling in his ankles. He also mentions occasional sharp, pleuritic chest pain that worsens with deep breaths. There is no history of trauma, fever, or recent infections.

On physical examination, the patient appears mildly dyspnoeic and has bilateral lower extremity oedema. His blood pressure is 120/75 mmHg, heart rate is 95 beats per minute, and respiratory rate is slightly elevated. Auscultation reveals muffled heart sounds. There are no signs of jugular venous distention or hepatomegaly. A chest X-ray shows an enlarged cardiac silhouette, and an echocardiogram reveals an accumulation of fluid in the pericardial sac, consistent with pericardial effusion.

The patient is diagnosed with pericardial effusion and is started on diuretics to reduce the fluid buildup. He is referred for further management to assess the underlying cause of the effusion, including possible pericardiocentesis if the effusion worsens or causes significant symptoms.