Where’s the fluid?
It’s actually in two places. This is a parasternal long axis view of the heart. The apex is to the left. The structure that I circled in white is the descending thoracic aorta. The anechoic fluid marked with two X’s is a pericardial effusion. The anechoic pocket I marked with an * is a left sided pleural effusion.
Sometimes identifying fluid location on TTE can be tricky, especially if your windows are difficult. It is important to identify the descending thoracic aorta on your parasternal long window, as this can give you a clue to fluid location. Pericardial fluid will be anterior to the aorta, and will often create separation between the aorta and the heart. Pleural effusion will usually be noted lateral or posterior to the aorta. This image is an example of both.