Radiological Insights Into the Pericardium: A Comprehensive Review

Figures

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  FIGURE 1. (A) Scheme of pericardial recesses. (B–G) Anatomy of pericardial recesses in CT. 1: superior aortic recess of transverse sinus, 2: right pulmonic recess of transverse sinus, 3: left pulmonic recess of transverse sinus, 4: postcaval recess, 5: right pulmonary venous recess, 6: left pulmonary venous recess, 7: oblique sinus, 8: inferior aortic recess of the transverse sinus. A, aorta; P, Pulmonary artery; RIPV–LIPV, right and left inferior pulmonary veins; RSPV–LSPV, right and left superior pulmonary veins; SVC–IVC, superior and inferior vena cava; TS, transverse sinus.

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  FIGURE 2. 21‐year‐old patient with a history of trauma. Chest radiography shows air in the pericardium, visible as a radiolucent zone commonly referred to as a ‘halo’—encircling the heart. The parietal pericardium appears as a radiopaque line (arrows).

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  FIGURE 3. 58‐year‐old patient. Chest radiography: (A) frontal and (B) lateral views. The cardiac silhouette is enlarged, resembling a ‘water bottle’ appearance. (B) The lateral view demonstrates the ‘Oreo cookie sign’ (arrows). (C) Axial CT and (D) sagittal reconstruction confirm the ‘Oreo cookie sign’, corresponding to the chest radiography findings (arrows).

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  FIGURE 4. 61‐year‐old patient with a 30‐day history of cardiac valve replacement. (A) Posteroanterior (PA) chest radiography shows an aortic valve replacement and an enlarged cardiac silhouette. A right pleural effusion is present, suggesting a subpulmonary location. (B) The lateral chest projection reveals a collection extending from the pericardium to the prevascular mediastinum, causing compression of the right cardiac chamber. (C) Axial and (D) coronal CT images demonstrate a mildly hyperdense collection extending from the pericardium to the prevascular mediastinum, exerting compression on the right cardiac chamber (arrows). Gas bubbles are also observed (arrows).

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  FIGURE 5. Patient with a history of primitive neuroectodermal tumour. (A) Axial chest CT in the mediastinal window shows a marked increase in pericardial fluid with diffuse nodular thickening. (B) PET‐CT demonstrates diffuse FDG uptake.

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  FIGURE 6. 51‐year‐old patient with a history of a pericardial defect. (A) Chest radiography shows displacement of the cardiac chambers toward the left. (B, C) Axial CT scan demonstrates rotation of the heart toward the left hemithorax.

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  FIGURE 7. 54‐year‐old patient. Axial CT scan in the mediastinal window shows multiple vascular dilatations in the anterior pericardium extending through the prevascular mediastinum, consistent with pericardial varices (arrows).