Pericardial effusions accompany a number of clinical conditions. The challenges facing the clinician when dealing with a pericardial effusion include assessing the urgency of draining the effusion, choosing the right approach for drainage, determining the mechanics of the effusion, and establishing a cause for the effusion. Currently available diagnostic methods, echocardiographic modalities in particular, greatly aid in the diagnostic assessment as well as in carrying out appropriate therapeutic strategies.