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Pericardial Sinuses and Recesses: Findings at Electrocardiographically Triggered Electron-Beam CT¹

¹ From the Department of Radiology, University Hospital Graz, Auenbruggerplatz 9, A-8036 Graz, Austria. Received April 14, 1998; revision requested May 29; final revision received October 30; accepted February 12, 1999. Address reprint requests to R.G.

View larger version (137K): [in a new window]   Figure 1. Electron-beam CT image of the mediastinum. The pericardium appears as a thin band (arrows) in the anterior mediastinum.

View larger version (66K): [in a new window]   Figure 2a. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–d) corresponding electron-beam CT images (obtained in different patients) at the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The pericardium (short white arrow) is seen in the anterior mediastinum. (b–d) The left pulmonic recess (straight white arrow) lies lateral to the main pulmonary artery. The posterior pericardial recess (curved arrow) of the oblique sinus is posterior to the right pulmonary artery and medial to the bronchus. The anterior portion of the superior aortic recess, right lateral portion of the superior aortic recess, and posterior portion of the superior aortic recess (black arrows) also are seen.

View larger version (136K): [in a new window]   Figure 2b. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–d) corresponding electron-beam CT images (obtained in different patients) at the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The pericardium (short white arrow) is seen in the anterior mediastinum. (b–d) The left pulmonic recess (straight white arrow) lies lateral to the main pulmonary artery. The posterior pericardial recess (curved arrow) of the oblique sinus is posterior to the right pulmonary artery and medial to the bronchus. The anterior portion of the superior aortic recess, right lateral portion of the superior aortic recess, and posterior portion of the superior aortic recess (black arrows) also are seen.

View larger version (117K): [in a new window]   Figure 2c. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–d) corresponding electron-beam CT images (obtained in different patients) at the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The pericardium (short white arrow) is seen in the anterior mediastinum. (b–d) The left pulmonic recess (straight white arrow) lies lateral to the main pulmonary artery. The posterior pericardial recess (curved arrow) of the oblique sinus is posterior to the right pulmonary artery and medial to the bronchus. The anterior portion of the superior aortic recess, right lateral portion of the superior aortic recess, and posterior portion of the superior aortic recess (black arrows) also are seen.

View larger version (131K): [in a new window]   Figure 2d. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–d) corresponding electron-beam CT images (obtained in different patients) at the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The pericardium (short white arrow) is seen in the anterior mediastinum. (b–d) The left pulmonic recess (straight white arrow) lies lateral to the main pulmonary artery. The posterior pericardial recess (curved arrow) of the oblique sinus is posterior to the right pulmonary artery and medial to the bronchus. The anterior portion of the superior aortic recess, right lateral portion of the superior aortic recess, and posterior portion of the superior aortic recess (black arrows) also are seen.

View larger version (69K): [in a new window]   Figure 3a. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b, c) corresponding electron-beam CT images (obtained in different patients) below the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RAA = right atrial appendage, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The oblique sinus (curved white arrow) is posterior to the right pulmonary artery and left atrium. The postcaval recess (straight black arrow) may be seen at the same level lateral and posterior to the superior vena cava. (b, c) The transverse sinus (curved black arrow) lies posterior to the ascending aorta. (c) The right pulmonic recess (open arrow) extends posteriorly below the right pulmonary artery.

View larger version (118K): [in a new window]   Figure 3b. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b, c) corresponding electron-beam CT images (obtained in different patients) below the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RAA = right atrial appendage, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The oblique sinus (curved white arrow) is posterior to the right pulmonary artery and left atrium. The postcaval recess (straight black arrow) may be seen at the same level lateral and posterior to the superior vena cava. (b, c) The transverse sinus (curved black arrow) lies posterior to the ascending aorta. (c) The right pulmonic recess (open arrow) extends posteriorly below the right pulmonary artery.

View larger version (124K): [in a new window]   Figure 3c. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b, c) corresponding electron-beam CT images (obtained in different patients) below the level of the right pulmonary artery (RPA). In a, AA = ascending aorta, B = bronchus intermedius, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, MPA = main pulmonary artery, RAA = right atrial appendage, RSPV = right superior pulmonary vein, SVC = superior vena cava. (See Key Box for abbreviation expansions not given here.) (b) The oblique sinus (curved white arrow) is posterior to the right pulmonary artery and left atrium. The postcaval recess (straight black arrow) may be seen at the same level lateral and posterior to the superior vena cava. (b, c) The transverse sinus (curved black arrow) lies posterior to the ascending aorta. (c) The right pulmonic recess (open arrow) extends posteriorly below the right pulmonary artery.

View larger version (68K): [in a new window]   Figure 4a. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–e) corresponding electron-beam CT images (obtained in different patients) at the level of the left atrium (LA). In a, AA = ascending aorta, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, RA = right atrium, RAA = right atrial appendage, RSPV = right superior pulmonary vein, RVAT = right ventricular outflow tract. (See Key Box for abbreviation expansions not given here.) (b–d) The inferior aortic recess (straight black arrow in b and c) extends downward behind the ascending aorta. The superior aortic recess (short arrow in c) also is seen. The left pulmonic vein recess (straight white arrow) is between the left pulmonic veins. The oblique sinus (curved arrow in b and d) lies posterior to the left atrium. (e) The right pulmonic vein recess (arrow) is adjacent to the right pulmonic veins.

View larger version (157K): [in a new window]   Figure 4b. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–e) corresponding electron-beam CT images (obtained in different patients) at the level of the left atrium (LA). In a, AA = ascending aorta, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, RA = right atrium, RAA = right atrial appendage, RSPV = right superior pulmonary vein, RVAT = right ventricular outflow tract. (See Key Box for abbreviation expansions not given here.) (b–d) The inferior aortic recess (straight black arrow in b and c) extends downward behind the ascending aorta. The superior aortic recess (short arrow in c) also is seen. The left pulmonic vein recess (straight white arrow) is between the left pulmonic veins. The oblique sinus (curved arrow in b and d) lies posterior to the left atrium. (e) The right pulmonic vein recess (arrow) is adjacent to the right pulmonic veins.

View larger version (124K): [in a new window]   Figure 4c. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–e) corresponding electron-beam CT images (obtained in different patients) at the level of the left atrium (LA). In a, AA = ascending aorta, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, RA = right atrium, RAA = right atrial appendage, RSPV = right superior pulmonary vein, RVAT = right ventricular outflow tract. (See Key Box for abbreviation expansions not given here.) (b–d) The inferior aortic recess (straight black arrow in b and c) extends downward behind the ascending aorta. The superior aortic recess (short arrow in c) also is seen. The left pulmonic vein recess (straight white arrow) is between the left pulmonic veins. The oblique sinus (curved arrow in b and d) lies posterior to the left atrium. (e) The right pulmonic vein recess (arrow) is adjacent to the right pulmonic veins.

View larger version (130K): [in a new window]   Figure 4d. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–e) corresponding electron-beam CT images (obtained in different patients) at the level of the left atrium (LA). In a, AA = ascending aorta, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, RA = right atrium, RAA = right atrial appendage, RSPV = right superior pulmonary vein, RVAT = right ventricular outflow tract. (See Key Box for abbreviation expansions not given here.) (b–d) The inferior aortic recess (straight black arrow in b and c) extends downward behind the ascending aorta. The superior aortic recess (short arrow in c) also is seen. The left pulmonic vein recess (straight white arrow) is between the left pulmonic veins. The oblique sinus (curved arrow in b and d) lies posterior to the left atrium. (e) The right pulmonic vein recess (arrow) is adjacent to the right pulmonic veins.

View larger version (133K): [in a new window]   Figure 4e. (a) Cross-sectional drawing of the pericardial sinuses and recesses and (b–e) corresponding electron-beam CT images (obtained in different patients) at the level of the left atrium (LA). In a, AA = ascending aorta, DA = descending aorta, E = esophagus, LAA = left atrial appendage, LSPV = left superior pulmonary vein, RA = right atrium, RAA = right atrial appendage, RSPV = right superior pulmonary vein, RVAT = right ventricular outflow tract. (See Key Box for abbreviation expansions not given here.) (b–d) The inferior aortic recess (straight black arrow in b and c) extends downward behind the ascending aorta. The superior aortic recess (short arrow in c) also is seen. The left pulmonic vein recess (straight white arrow) is between the left pulmonic veins. The oblique sinus (curved arrow in b and d) lies posterior to the left atrium. (e) The right pulmonic vein recess (arrow) is adjacent to the right pulmonic veins.