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Left ventricular( LV) tamponade is rare and can occur in special circumstances like regional pericardial effusion overlying LV. The therapeutic approach of LV tamponade is different according to the causative factor and the place of loculated pericardial effusion. We report a case of neoplastic cardiac tamponade manifesting as left ventricular diastolic dysfunction. A 78-year-old man with a history of aortic arch surgery and lung cancer surgery presented with dyspnea. Echocardiogram showed posterior loculated pericardial effusion and LV diastolic dysfunction. Pericardial window operation was performed, then revealed bloody effusion and cytodiagnosis examination revealed class V( adenocarcinoma). Atypical forms of cardiac tamponade with varied clinical presentations may be seen in patients after cardiac surgery. It is important to accurately understand the pathological condition through clinical progress and echocardiography, and to select an appropriate approach and surgical procedure.