Echocardiographic simulation of pericardial effusion by ascites

Subcostal echocardiography in patients with tense ascites can reveal an echo-free space anterior to the heart which could be mistaken for a loculated anterior pericardial effusion or a pericardial cyst. The ascitic nature of the space can be recognized by the contours of the space, its relationship to the liver, and to the distinctive midline appearance of the falciform ligament of the peritoneum bisecting the space. Less frequently ascitic fluid inferior to the left ventricle, between it and an enlarged spleen, can mimic a posterior pericardial effusion, on M-mode and even long-axis 2-D echography, but the ascitic nature of the space is evident on the short-axis 2-D view.