This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Takotsubo Cardiomyopathy and Brugada Syndrome, Subject name: Medicine
A 60-year-old smoker presents with breathlessness for 2 weeks. On examination: hea rate is 100/min, BP = 90/60 mm Hg and neck veins are distended with a palpable liver. CXR is shown. What is the probable diagnosis? 
Select and explain. 
A. Pericardial effusion, B. Cor pulmonale, C. Broken hea syndrome, D. Brugada syndrome
A: Pericardial effusion
Answer: A: Pericardial effusion 
Explanation: * Since in the CXR, the cardiac borders look bulging and CT ratio is increased, the finding is that of a water bottle hea/ money bag appearance. In clinical setting of hypotension with distended neck veins, this patient is having a massive pericardial effusion and developing findings of a tamponade. * The point against cor pulmonale is that it is characterized by right ventricular failure with pulmonary aery hypeension. But in this CXR, pulmonary aery segment is not bulging.