Accurate diagnosis of severe aortic stenosis is important for timely valve replacement. Peak aortic velocity and gradient recordings require optimal aortic jet-ultrasound beam alignment, which may be challenging in patients with poor acoustic windows due to obesity, lung disease, chest deformities, skin lesions, or surgical scars. In these clinical settings, alternative acoustic windows, notably the posterior thoracic window, can be helpful. However, in order to use the posterior thoracic window, some degree of left pleural effusion must be present.