School ager with 1 week of abdominal pain and shortness of breath

CXR and US of pericardial effusion due to histoplasmosis
AXR (above left) shows hepatomegaly and an enlarged cardiac silhouette. CXR (above right) shows a water-bottle appearance to the cardiac silhouette and bilateral pleural effusions and bilateral hilar lymphadenopathy. Transverse US of the heart (below) shows a large anechoic fluid collection in the pericardial space.

The diagnosis was pericardial effusion due to histoplasmosis.