UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis?

Posted: 11/10/2014 by Haney Mallemat, MD (Emailed: 11/11/2014)
Click here to contact Haney Mallemat, MD


Parasternal long-axis of two different patients. What is the:

  1. structure labeled “A”
  2. structure labeled “B”
  3. diagnosis on the left?
  4. diagnosis on the right?



  1. A = Left atrium
  2. B = Descending aorta
  3. Left clip = Pericardial effusion
  4. Right clip = Pleural effusion

Take home pearl: when there is fluid behind the heart, the parasternal long-axis view of the heart is helpful to distinguish between a pleural effusion and a pericardial effusion.

  • Step 1: Find the descending aorta and left atrium
  • Step 2: Is there fluid that crosses in-between the two?
    • If there is, then there is a pericardial effusion
    • If there is no fluid between, then it is a left pleural effusion


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