Pleuro – Pericardial effusion

A combination pleural and pericardial effusion is more common than we realise .

Here is a patient with  both  effusions.

• The etiology was tuberculosis.
• Twin pressure effect   increases the chances of tamponade
• Careful echocardiography is required to identify both .
• Large left  pleural effusion can mimic a pericardial effusion some times . A useful clue is looking at  the LV  apex.It is invariably free in pleural effusion.

Unanswered question

Is there a anatomical continuity between pleural and pericardial spaces ?