A combination pleural and pericardial effusion is more common than we realise .
Here is a patient with both effusions.
- The etiology was tuberculosis.
- Twin pressure effect increases the chances of tamponade
- Careful echocardiography is required to identify both .
- Large left pleural effusion can mimic a pericardial effusion some times . A useful clue is looking at the LV apex.It is invariably free in pleural effusion.
Unanswered question
Is there a anatomical continuity between pleural and pericardial spaces ?
Dr.S.Venkatesan MD 
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