Vera is a 20 year girl who was admitted 2 days ago with a months worth of cough and fever. She had been treated elsewhere with antibiotics without improvement. She was very ill appearing and also suffers from Sickle Cell Anemia and her hemoglobin was 6.0. Her Chest X-ray today showed a large heart shadow so Dr Ed and I did and ultrasound on her and she had the largest pericardial effusion that either of us has ever seen. She does not have HIV so she unlikely has Tuberculosis causing her Pericarditis.