Pericardial Recess: Computed Tomography Findings of Varying Disorders

Figures

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  Fig. 1. Schematic representation of the interior of the serosal pericardial sac after segmentation of the large vessels. Line diagram illustrating the posterior pericardial reflection, which forms the transverse and OS and their associated recesses. Line diagram of the pericardial sinuses and recesses after segmentation of the large vessels and removal of the heart. Pericardial sinuses are composed of a TS and an OS. The pericardial space is divided into two compartments: one surrounding the ‘A’ and the ‘P’ (double dashed lines), and another surrounding the vena cava and the pulmonary veins (single dashed lines). The TS is located between the two compartments. The TS is connected to the superior aortic recess (black arrow) and the left pulmonic recess (white arrow). The right and left pulmonary venous recesses (†) are located between the superior and the inferior pulmonary veins. The postcaval recess (*) is located behind the ‘S’. A = aorta, IVC = inferior vena cava, LIPV = left inferior pulmonary vein, LSPV = left superior pulmonary vein, OS = oblique sinus, P = pulmonary artery, RIPV = right inferior pulmonary vein, RSPV = right superior pulmonary vein, S = superior vena vaca, TS =…

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  Fig. 2. Cross-section of the pericardial sinuses and recesses. The pericardial sinuses are composed of the TS and the OS. The TS is connected to the aortic recess (straight arrow), the right pulmonic recess (curved arrow), and the LPR (open arrow). The aortic recess is divided into the superior and the inferior aortic recesses. The SAR is the uppermost portion of the TS and extends upward along the right side of the ‘A’ usually to the level of the sternal angle. The SAR is subdivided into the anterior (single dot), the right lateral (two dots) and the posterior (three dots) sections. The LPR is located between the proximal portion of the right main ‘P’ and the LSPV, below the left main ‘P’. The OS lies behind the left atrium anterior to the ‘e’. The PPR of the OS is located posterior to the right ‘P’ and medial to the Br. The postcaval recess (*) behind the ‘S’ is a diverticulum of the pericardial cavity proper. The left pulmonic venous recess is located posterior to the LSPV. A = aorta, B = left main bronchus, Br = bronchus intermedius, e = esophagus, LPR = left pulmonic recess, LSPV = left superior pulmonary vein, OS = oblique sinus, P = pulmonary artery, PPR = posterior pericardial…

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  Fig. 3. Change in size of the pericardial recess in a 65-year-old woman. A. Initial chest radiograph shows a small right mediastinal bulge (arrows), and an increased right mediastinal bulge and an enlarged cardiac size are seen on chest radiograph obtained 3 years later. B. Axial CT image shows fluid collection (*) at the right lateral portion of the superior aortic recess, extending to the right cardiac border. Fluid collection at the cardiac border (*) is increased on CT obtained three years later. The size variation of the pericardial recess may be related to the amount of pericardial effusion rather than the cardiac size per se. A = aorta, P = pulmonary artery, S = superior vena cava

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  Fig. 4. Pneumopericardium in a 17-year-old boy. A, B. Serial axial (A) and coronal (B) images show air in anterior (triple arrows), posterior (paired arrows) and right lateral (arrows) portions of the superior aortic recess. A pneumopericardium is seen at the transverse sinus (arrowheads) posterior to the ascending thoracic ‘A’ in the axial view and below the main ‘P’ in the coronal view. Air was also detected at the postcaval recess (open arrowhead) and the left pulmonic recess (open arrows). A = aorta, P = pulmonary artery, S = superior vena cava

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  Fig. 5. The anterior and posterior portions of the superior aortic recess in a 55-year-old man. Axial and coronal images show anterior (†) and posterior (*) portions of the superior aortic recess with a gap (arrows). This finding suggests that the superior aortic recess incompletely surrounds the ascending thoracic aorta.

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  Fig. 6. The right lateral portion of the superior aortic recess in an 86-year-old woman. Serial axial and reformatted oblique sagittal images show a cystic mass (*) at the right anterior mediastinum, with contiguity (arrows) to the right lateral portion of the superior aortic recess. A = aorta, P = pulmonary artery, S = superior vena cava

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  Fig. 7. Pneumopericardium in a 62-year-old man, who was admitted due to a motorcycle accident. Serial axial images show an air shadow in the high-riding superior pericardial recess (*) and the pericardial space proper (†). A = aorta, S = superior vena cava, T = trachea

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  Fig. 8. Aortopulmonary window recess in a 37-year-old woman. Serial axial and coronal images show fluid collection (arrows) along the aortic arch extending superior and posterior above the aortic arch (open arrows). A = aorta, P = pulmonary artery, S = superior vena cava

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  Fig. 9. Loculated pericardial effusion at the inferior aortic recess in a 46-year-old woman. Serial axial and coronal images show loculated pleural effusion at the inferior aortic recess (*). It can mimic a cystic mass. A = aorta, P = pulmonary artery, S = superior vena cava

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  Fig. 10. Pericardial metastasis from breast cancer in a 49-year-old woman. A, B. Serial axial (A) and coronal (B) images show irregular enhanced masses in the superior aortic recess (arrows), the left pulmonic recess (black dot), the transverse sinus (*) and the inferior aortic recess (†). A = aorta, LA = left atrium, P = pulmonary artery, S = superior vena cava

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  Fig. 11. Right pulmonary venous recess in a 4-year-old boy. Serial axial, coronal and sagittal images show fluid collection in the posterior (open arrows) and inferior (arrows) sleeves of the right inferior ‘V’. Coronal image shows fluid collection in the inferior sleeve (arrows) of the right inferior ‘V’. As the pulmonary veins penetrate the fibrous pericardium to enter the LA, a serosal sleeve of the pericardium surrounds the veins. At the level of the inferior ‘V’, pericardial fluid in the sleeve can be misinterpreted as adenopathy. LA = left atrium, V = pulmonary vein

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  Fig. 12. Hemopericardium by aortic dissection in a 70-year-old man. Serial axial images show a high-attenuation hematoma at the inferior aortic recess (*), the transverse sinus (†) and the left pulmonic recess (‡). A = aorta, P = pulmonary artery, S = superior vena cava