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©2013 UpToDate ® Print Email 4 chamber view showing circumferential pericardial effusion The apical four chamber view shows a moderate to large anterior and posterior pericardial effusion (PE), but the curvature of the right atrium (RA) is normal. In panel B there is diastolic expiratory invagination, compression, or collapse of the RA. Collapse of the right atrium is a highly sensitive, but relatively nonspecific, sign of hemodynamically important tamponade. More importantly, the left atrium (LA) also appears compressed. This latter sign is felt to be more specific for tamponade. RV: right ventricle; LV: left ventricle.