text:  PHYSICAL EXAMINATION ON PRESENTATION The patient had a temperature of 100.9 . He had a blood pressure of 148 to 162  45 to 54 . He had a heart rate of 85 to 87   breathing at 17 to 23   satting 100 on room air . In general   he was alert and in no acute distress . His neck was supple without any jugular venous distention . HEENT examination revealed his pupils were equal   round   and reactive to light . His extraocular movements were intact . His sclerae were anicteric . His mucous membranes were moist . His oropharynx was benign . Cardiovascular revealed a regular rate and rhythm   heart sounds muffled   no murmurs . Respiratory revealed bibasilar rales . Abdomen was soft   nontender   and nondistended   positive bowel sounds . Extremities revealed trace lower extremity edema   right greater than left   2 dorsalis pedis and posterior tibialis pulses . He had 2 femoral pulses bilaterally . No hematomas were noted   but a soft right femoral bruit was heard . LABORATORY DATA ON PRESENTATION  The patient had a white blood cell count of 9.5   a hematocrit of 34.5   a platelet count of 194 . His Chem-7 revealed sodium of 132   potassium of 43   chloride of 97   bicarbonate of 28   BUN of 25   creatinine of 1.3   glucose of 220 . He had an INR of 1.1 . A calcium of 8.4   phosphate of 2.5   magnesium of 1.9 . Pericardial fluid analysis was consistent with an exudative etiology . RADIOLOGY    IMAGING  The patient had an electrocardiogram with normal sinus rhythm at 70   normal axis   normal intervals   low voltage in the limb leads . Chest x-ray on admission revealed a large left pleural effusion . The patient had an echocardiogram on 11-10 which revealed the following  Global left ventricular systolic function appeared grossly preserved . Due to technical quality a focal wall motion abnormality could not be fully excluded . The aortic valve leaflets were mildly thickened . The mitral valve leaflets were mildly thickened . There was a large pericardial effusion  up to greater than 6 cm wide anterior to the right ventricle . The right ventricle was compressed .