Fluid retention in decompensated hepatic cirrhosis is frequently accompanied by edema, ascites, and hydrothorax. Whether pericardial effusion occurs in such patients has not been studied. Twenty-seven consecutively hospitalized patients with ascites secondary to alcoholic cirrhosis of the liver were studied, and 28 control subjects were studied with the use of an echocardiographic method to detect pericardial effusion and to evaluate their left ventricular (LV) function. Seventeen patients (63%) and three control subjects (11%) showed pericardial effusion. The prevalence of pericardial effusion in the patients was significantly greater than in the control subjects (chi 2 = 10.6). Although the mean values of the echocardiographic measurements of LV function of the patients and the control subjects did not differ significantly, the individual values of the patients varied considerably. Among the patients, six patients (27%) had LV dysfunction, 14 patients (64%) had normal values, and two patients (9%) had values suggestive of hypercontractility of the left ventricle. Furthermore, abnormal systolic motions of the mitral valve and/or septum were noted in eight patients (30%) but in none of the control subjects. Six patients with pericardial effusion on initial examination were evaluated after the resolution of their ascites; pericardial effusion disappeared in two patients, diminished in two others, and remained unchanged in two patients. Resolution of ascites was also associated with normalization of the systolic motion of the mitral valve and septum. It was concluded that pericardial effusion is common in patients with ascites secondary to alcoholic hepatic cirrhosis and that its presence is probably related to fluid retention.