Representative case. Volumetric analysis of the CT pulmonary angiography (CTPA) of a 77-year-old male who presented to the emergency department with shortness of breath and clinical signs of right heart failure. CTPA ruled out pulmonary embolism, but there was a large pericardial effusion. His volumetric analysis was LV volume 117 ml, LA volume 157.4 ml, RV volume 172.8 ml, and RA volume 195.5. Echocardiography showed a moderate pericardial effusion with no signs of hemodynamic significance. He was provisionally diagnosed as having combined diastolic heart failure with COPD and appropriate treatment led to significant improvement.