대한흉부영상의학회 Weekly Chest Cases

Case No : 416 Date 2005-10-17

Courtesy of Young Kyung Lee, MD, Kyung-Hyun Do, MD, Joon Beom Seo, MD / Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Age/Sex 62 / F
Chief ComplaintIntermittent chest discomfort

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Diagnosis With Brief Discussion

Diagnosis: High-Riding Superior Pericardial Recess
Radiologic Findings: Chest CT scans show round water-attenuation lesion in right paratracheal area above aortic arch, extending to inferior portion of superior pericardial recess in typical location. Note that lesion is molded by adjacent vascular structures. There was no evidence of pericardial effusion.
Brief Review: The superior pericardial recess also known as the superior sinus of the pericardium and as the posterior division of the superior aortic recess of the pericardium usually manifests as a half moon뾱haped fluid collection adjacent to the posterior wall of the ascending aorta. Although the superior pericardial recess usually appears just caudad to the aortic arch, it sometimes extends from this typical location cephalad and rightward into the right paratracheal region between the brachiocephalic vessels and the trachea, even in patients without pericardial effusion. We call this the high-riding superior pericardial recess. On CT, the high-riding superior pericardial recess typically manifested as a triangular, round, or oval structure that extended along the posterolateral wall of the ascending aorta from the typical location of the superior pericardial recess into the right paratracheal region. This recess usually extended up to the level of the transverse aortic arch and was surrounded anteriorly by both brachiocephalic veins and the right brachiocephalic artery, simulating a mass or lymphadenopathy on CT. Recognition that this high-riding portion of the recess is of water attenuation, that it connects to the inferior portion of the superior pericardial recess on caudal CT images, and that it does not exert mass effect on adjacent structures should help avert misdiagnosis. Narrow-collimation CT with multiplanar reformations can be useful for confidently showing the connection between the high-riding and inferior portions of the superior pericardial recess.
References: Choi YW, McAdams HP, Jeon SC, Seo HS and Hahm CK. The High-Riding Superior Pericardial Recess: CT Findings. AJR 2000; 175:1025-1028
Keywords: Mediastinum, Congenital,

No. of Applicants : 33

▶ Correct Answer : 4/33, 12.1%

- Fleury Medical Center, Sao Paulo, Brazil Gustavo Meirelles
- Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
- Samsung Medical Center, Seoul, Korea Ha Young Kim
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh

▶ Correct Answer as Differential Diagnosis : 2/33, 6.1%

- Busan National UniversityHospital, Korea Su-mi Shin
- Max Hospital, New Delhi, India Vickrant Malhotra

▶ Semi-Correct Answer : 9/33, 27.3%

- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Monaldi Hospital, Naples, Italy Gaetano Rea
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
- Annecy Hospital, France Gilles Genin

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 416 Date 2005-10-17

Discussion

No. of Applicants : 33