Large pericardial effusion

The long-axis precordial view shows a large APE and PPE. A key landmark for a PPE is it tracks anterior to the descending aorta. The distinction between this large effusion and a moderate-sized one is the easily seen anterior accumulation. Since the volume of the effusion is a cube function of its dimensions, its presence circumferentially makes a large difference in its volume without a major qualitative change in appearance.