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Anemia is sometimes the sole cause of enlargement of the so-called cardiac silhouette. Successful treatment of the anemia may then restore the silhouette to normal. The enlargement has been attributed to cardiac dilatation. Because of the recognized difficulty in distinguishing pericardial effusion from cardiac dilatation, direct puncture was attempted in two instances of anemia with the silhouette enlarged presumably due to dilatation. In each instance, the enlargement was demonstrated to be due almost exclusively to pericardial effusion.

Pericardial Effusion Mistaken for Cardiac Enlargement in Severe Anemia