Pericardial effusion "in snowfall"

A 23-year-old young man with discovery acute leukemia admitted for pre-chemotherapy echocardiography. Transthoracic echocardiography (four cavity (A) and two cavity (B)) found good systolic function of the left ventricle with moderate circumferential pericardial effusion containing hyperechoic micronodules give the appearance like "snowfall" without hemodynamic repercussions. This aspect of pericardial effusion, never described, can be paraneoplastic or reactive due to the leukemia. The evolution after chemotherapy was favorable with disappearance of hyperechoic nodules and then the effusion.