A 35 year old man presented to the casualty department with a two week history of malaise, dyspnoea, and pleuritic chest pain. His temperature was 38°C, blood pressure 100/75 mm Hg, pulse 105 beats/min and regular, and the heart sounds were quiet. A 12 lead ECG was unremarkable. Chest radiography showed an enlarged cardiac silhouette. Transthoracic echocardiography confirmed a 2 cm pericardial effusion. Pericardiocentesis was performed via the subxiphoid route with the aid of contrast echocardiography (fig 1). Serology and other investigations suggested a viral aetiology. The catheter was removed after 48 hours and the patient successfully discharged home.