The diaphragm was incongruent, and it was easily visualized that the liver was traversing into the thoracic cavity. The hepatic veins and vena cava appeared to be dilated. There were cysts noted within the abdominal liver, with a very large cyst noted in the thoracic liver, which filled the majority of the pericardial sac. After the fluid was removed from the pericardial sac, the stomach was noted to traverse into the diaphragmatic hernia as well. The heart was noted to be compressed by a very large fluid filled cyst within the pericardial sac and was difficult to image. The large bi-lobed cyst appeared to originate from the hepatic parenchyma within the pericardium. The cyst was drained by a pericardiocentesis and 128mls of straw colored fluid was removed. After the tap, the echocardiogram revealed normal fractional shortening, normal atrial and ventricular size, wall thicknesses and flow profiles through all outflow tracts. After the tap was performed, it was noted that the liver directly adjacent to the heart had hyperechoic densities within it and was more abnormal and coarse in appearance.