The “High-Riding” Superior Pericardial Recess

Abstract

OBJECTIVE. We recently observed patients in whom the superior pericardial recess extended cephalad ("high-riding") into the right paratracheal region. In these patients, differentiation from mediastinal lymphadenopathy or mass was difficult. The purpose of this study was to assess the prevalence and CT features of the high-riding superior pericardial recess. CONCLUSION. Narrow-collimation CT with multiplanar reformations was useful for confidently diagnosing a high-riding superior pericardial recess and for distinguishing it from pathologic lesions.

Chest Including Lungs and Mediastinum

“…12.35 ). Coronal CT demonstration of continuation of this cystic area with the superior pericardial recess is useful for confi rmation (Choi et al 2000 ). Pericardial recess accompanying the pulmonary vein can also be confused with a lymph node (Truong et al 2003 ) (Fig.…”

Not Everything That Looks like a Lymph Node Is a Lymph Node: A Pitfall for Transbronchial Needle Aspiration

“…The posterior portion of this pericardial recess lies between the posterior wall of the ascending aorta and the trachea (superior pericardial recess or superior sinus) and it can be recognized on a CT scan in up to 50% of healthy subjects as a curvilinear, 'halfmoon' or triangular-shaped, near-water-density structure [7] . Sometimes (2-6% of normal subjects), this recess extends cephalad and rightwards into the right paratracheal region (the so-called 'high-riding' superior pericardial recess) and may mimic right paratracheal lymphoadenopathy or a cystic mediastinal lesion [8,9] .…”

“…The answer is yes. In fact, looking at figure 1 of Gross and Diacon [10] , some aspects were present that radiologists have described as useful signs to distinguish between a lymph node and a pericardial recess [7][8][9]11] . The internal homogeneity of the lesion, its 'half-moon' shape, the direct contact with the aorta and the absence of an intervening fat plane between the lesion and the artery are all evident in the CT scan of the reported case.…”

Pericardium: Anatomy and spectrum of disease on computed tomography

“…Among these structures, the transverse sinus and its subdivisions frequently simulate abnormalities such as lymphadenopathy or mediastinal mass. [2][3][4] The transverse sinus is posterior to the ascending aorta and pulmonary trunk and above the left atrium (Fig 2, A). Vesely and Cahill 5 subdivided the transverse sinus into 4 recesses: the superior aortic, the inferior aortic, the right pulmonic, and the left pulmonic.…”

“…6 Even in patients without pericardial effusion, a significant part of the posterior portion may extend cephalad into the right paratracheal region (the "high-riding" superior pericardial recess) (Fig 3). 3 The left pulmonic recess is situated below the left pulmonary artery and posterolateral to the proximal portion of the right pulmonary artery (Fig 2, C). 2 Recognizing the appearance of these normal variations is extremely important to avoid misidentification as lymphadenopathy and other mediastinal disease processes.…”