Echocardiographic swinging heart motion in loculated anterior pericardial effusion

A patient in chronic renal failure presented with cardiomegaly. Echocardiography and cardiac scan demonstrated loculated anterior pericardial effusion. Another unusual echocardiographic feature was the presence of swinging heart motion, usually seen only with large nonlocalized pericardial effusion. When dialysis led to substantial regression of cardiac size, the echocardiographic abnormalities disappeared.