Fig. 1

A, B Pre-procedural echocardiography views (apical 4-chamber and subxiphoid) revealing a large pericardial effusion concentrated maximally around the right atrium (dashed line and star). C Right parasternal ultrasonographic view displaying the pericardial effusion with fibrin strands, the surrounding vital structures (pleura, internal thoracic vessels (ITVs), and myocardium), the diameter of cardiac effusion A, and the path of needle insertion B (the distance from the skin to the pericardial space). D Image demonstrating the position of operator, ultrasound machine, and placement of high-frequency ultrasound probe in the right parasternal area