대한흉부영상의학회 Weekly Chest Cases

Case No : 137 Date 2000-06-10

Courtesy of Myeong Im Ahn, MD, / The Catholic University of Korea, St. Vincent's Hospital, Suwon, Korea
Age/Sex 27 / M
Chief ComplaintIncidental finding on chest CT. What does the arrow indicate?

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Diagnosis With Brief Discussion

Diagnosis: Superior Recess of Pericardial Sinus
Radiologic Findings: Contrast-enhanced CT scan shows a curvilinear low density just right lateral to the ascending aorta and the right innominate artery. The density of it is about 5-10 HU. No pericardial effusion was noted (not seen) at the inferior sections.
Brief Review: The pericardium consists of an outer fibrous envelope and an inner serous sac, which is invaginated by the heart. The serous pericardium can be divided into a visceral layer, or epicardium, which covers the heart and great vessels, and a parietal layer, which lines the fibrous pericardium. The visceral pericardium is reflected from the heart, along the great vessels, and onto the parietal pericardium. At these reflections and between the great vessels, recesses or sinuses are formed within the pericardial space. These include the superior pericardial recess, transverse and oblique sinuses, the left pulmonic recess, the pulmonary venous recesses, and the recesses around the superior and inferior vena cavae.
Under physiologic conditions, pericardial cavity contains 20-25mL of serous fluid; however, the amount of fluid may vary considerably among individuals, particularly in children and infants. These differences may explain, at least in part, why in some patients, sinuses or recesses may or may not be seen.
The knowledge of their location and appearance was considered to be helpful to the radiologists in avoiding the misdiagnosis of lymphadenopathy and other mediastinal disease processes, such as thymic, tracheobronchial, and esophageal lesions.
References: 1. Levy-Ravetch M, Auh YH, Rubinstein WA, et al. CT of the pericardial recesses. AJR 1984;144:707-714.
2. Groell R, Schaffler GJ, Rienmueller R. Pericardial sinuses and recesses: findings at electrocardiographically triggered electron-beam CT. Radiology 1999;212:69-73.
3. Choe YH, Im J, Park JH, et al. The anatomy of the pericardial space: a study in cadavers and patients. AJR 1987;149:693-697.
Keywords: Pericardium, Congenital,

No. of Applicants : 55

▶ Correct Answer : 49/55, 89.1%

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- 嫄곗갹
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- Dong-A University Hospital Ki-Nam Lee
- Gachon Medical School Gil Medical Center Seo Joon Beom
- Hospital General Universitario de Alicante, Spain Juan Arenas
- Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- Sabuk Yonsei Hospital Chun, Ho Jong
- Samsung Medical Center Kyung Soo Lee
- Seoul National University Hospital Choi Hyuck Jae
- Seoul National University Hospital Seong Ho Park
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Hospital de Guipuzcoa San Sebastian Spain Gonzalo Vega - Hazas Porrua

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 137 Date 2000-06-10

Discussion

No. of Applicants : 55