Spontaneous echo contrast is uncommon in pericardial effusion. We repo
rt the case of a patient with massive malignant pericardial effusion c
ausing cardiac tamponade in which the intense spontaneous echo contras
t was found in the effusion by echocardiography. It was suggested that
both the heavy blood content and a large amount of pericardial effusi
on were needed to create the phenomenon of spontaneous echo contrast i
n the pericardial cavity.