Horowitz et al classified pericardial effusions based on changes seen on echocardiography.
small effusion, 3 to 16 mL (variable systolic separation)
systolic and diastolic separation of epicardium and pericardium; small effusion > 16 mL
systolic and diastolic separation of epicardium and pericardium with attenuated pericardial motion (flat)
pronounced separation of epicardium and pericardium with large echo-free space (large effusion)
pericardial thickening (> 4 mm)
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