Coronary artery perforation (CAP) is a potentially fatal complication following percutaneous coronary intervention. The suspicion for post-procedural CAP typically arises from the development of clinical hemodynamic instability of the patient and evidence of new or worsening pericardial effusion in bedside echocardiography. Following such suspicion, emergent pericardiocentesis and immediate repeated coronary angiography should be performed to assess for coronary perforation. The use of echo-contrast material, currently used to improve echocardiographic resolution and provide real-time assessment of intracardiac blood flow evaluation, has yet been described to facilitate diagnosis of such infrequent complication without delaying invasive treatment in this setting.