A colleague recently picked up an occult pericardial effusion in a dialysis patient which required a pericardial window. The tip-off was the loss of nasolabial folds -- in a previous patient, she had seen facial swelling associated with a pericardial effusion, so she was suspicious enough to check an echocardiogram. Because she knew him well, she was able to pick up the subtle change in her patient's face.
