Left: small pericardial effusion with inferior basal localization.

Right: small pericardial effusion with posterior basal localization.

Left: circular, mid-size pericar- dial effusion, with posterior und lateral accentuation.

Right: mid-size pericardial effu- sion, as well as large pleural effusion clear delimitated through parietal pericardial line.

Left: mid-size to large pericardial effusion with severe hemodynamic compromise, as evidenced through RV compression.

Right: large, circular pericardial effusion. RV and LV filling show respiratory dependent compro- mise.

Left: this same case from the parasternal short axis. Aspirated volumen was 1.5 liters.

Right: inferior vena cava is plethoric and without respiratory collapse, a sign of hemodynamic severity.

Following images show charac- teristics of pericardial compres- sion.

Left: contraction of the free RV wall is impeded through the organized pericardial effusion. RV expands during filling at the beginning of each inspiration, only through a septal shift toward the LV (septal bounce).

Right: E-wave shows a clear (> 25 %) increase in inspiration (1).

Left: tricuspid regurgitation is also more evident during inspiration, here more accentuated as in physiologic status.

Right: tricuspid regurgitation maximal velocity becomes lower as EROA increases.

Left: inferior vena cava is plethoric and show no inspiratory collapse.

Right: antegrade velocities in suprahepatic vein also show clear respiratory accentuacion.