Cardiac tamponade is a life threatening condition. It is rarely the first sign of malignancy which can be diagnosed by cytological examination of pericardial fluid. Subcutaneous metastatic nodules also are an uncommon first sign of underlying cancer. In this report we present a 62 years old case of lung cancer who initially presented with the above two rare clinical signs. He was admitted with cardiac symptoms, chest pain and dyspnea since last 6 months. Chest radiographs showed cardiomegaly and diagnosis of cardiac tamponade was made. Pericardiocentesis showed malignant cells, morphologically suggestive of an adenocarcinoma. Fine needle aspiration of the subcutaneous nodules showed a similar picture. Search for the primary revealed a mass in the lung on computed tomography.