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In this patient with profound volume overload, the liver can be seen on the right side of the screen with the bright overlying diaphragm. A thin tentacle of atelectatic lung is visible waving in the anechoic effusion. A rib is visible on the left side of the screen casting a dense shadow. This is a good example of the best way to differentiate the dark rib shadow from anechoic fluid. The rib shadow goes all the way to the bottom of the screen, while the fluid causes the structures deep to it to appear brighter, due to posterior acoustic enhancement.