Other echocardiographic findings that can be seen with tamponade are diastolic collapse of the RV, systolic collapse of the right atrium (RA), or both. These findings are seen as pericardial volume and pressures increase and eventually exceed chamber pressures. The patient in this case had evidence of RA collapse, but did not have diastolic RV collapse. Systolic RA collapse is a highly sensitive sign of tamponade, however, it is not as specific as RV diastolic collapse.1 It should be noted that patients with infiltrative cardiac disease or RV hypertrophy may not display RV collapse. IVC plethora is another highly sensitive (97%), but not very specific, echocardiographic sign of tamponade.1 As pericardial pressures impede venous return, collapse of the IVC during respiration diminishes, resulting in a plethoric IVC. In contrast, a collapsing IVC is generally not seen in patients with tamponade. Because multiple physiologic states can cause a plethoric IVC, the clinical context is central to making the diagnosis of tamponade. In a patient with shock, a circumferential and large effusion, visible both anteriorly and posteriorly, may be the only suggestion of possible tamponade. Given the ranges of sensitivity and specificity of the above-described signs, it is important that the clinician be proficient at evaluating the echocardiographic findings that can be seen with tamponade.