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The "High-Riding" Superior Pericardial Recess

CT Findings

¹ Department of Radiology, Hanyang University Hospital, 17 Haengdang-dong, Sungdong-ku, Seoul 1333-792, South Korea.
² Department of Radiology, Duke University Medical Center, Durham, NC 27710.

View larger version (73K): [in a new window]   Fig. 1A. —"High-riding" superior pericardial recess in 67-year-old woman with history of tuberculosis in right upper lobe. Contiguous chest CT scans (3-mm collimation) show triangular water-attenuation lesion (solid arrows, A and B) in right paratracheal area above aortic arch, extending to inferior portion of superior pericardial recess in typical location (open arrow, C). Note that lesion is molded by adjacent vascular structures. Attenuation of lesion (asterisk, A) measured 15 H. We saw no evidence of pericardial effusion on caudal scans (not shown).

View larger version (64K): [in a new window]   Fig. 1B. —"High-riding" superior pericardial recess in 67-year-old woman with history of tuberculosis in right upper lobe. Contiguous chest CT scans (3-mm collimation) show triangular water-attenuation lesion (solid arrows, A and B) in right paratracheal area above aortic arch, extending to inferior portion of superior pericardial recess in typical location (open arrow, C). Note that lesion is molded by adjacent vascular structures. Attenuation of lesion (asterisk, A) measured 15 H. We saw no evidence of pericardial effusion on caudal scans (not shown).

View larger version (77K): [in a new window]   Fig. 1C. —"High-riding" superior pericardial recess in 67-year-old woman with history of tuberculosis in right upper lobe. Contiguous chest CT scans (3-mm collimation) show triangular water-attenuation lesion (solid arrows, A and B) in right paratracheal area above aortic arch, extending to inferior portion of superior pericardial recess in typical location (open arrow, C). Note that lesion is molded by adjacent vascular structures. Attenuation of lesion (asterisk, A) measured 15 H. We saw no evidence of pericardial effusion on caudal scans (not shown).

View larger version (92K): [in a new window]   Fig. 1D. —"High-riding" superior pericardial recess in 67-year-old woman with history of tuberculosis in right upper lobe. Oblique coronal reformatted CT scan reveals connection between high-riding (arrows) and inferior (arrowhead) portions of superior pericardial recess.

View larger version (112K): [in a new window]   Fig. 2A. —"High-riding" superior pericardial recess in 62-year-old woman with bilateral pleural effusion. Contiguous CT scans (3-mm collimation) show 20-mm-diameter right paratracheal mass (arrows, A and B) with typical features of high-riding superior pericardial recess, including low-attenuation, connection with inferior portion of superior pericardial recess (arrowhead, C), and molded appearance. We saw no evidence of pericardial effusion on caudal scans (not shown).

View larger version (129K): [in a new window]   Fig. 2B. —"High-riding" superior pericardial recess in 62-year-old woman with bilateral pleural effusion. Contiguous CT scans (3-mm collimation) show 20-mm-diameter right paratracheal mass (arrows, A and B) with typical features of high-riding superior pericardial recess, including low-attenuation, connection with inferior portion of superior pericardial recess (arrowhead, C), and molded appearance. We saw no evidence of pericardial effusion on caudal scans (not shown).

View larger version (125K): [in a new window]   Fig. 2C. —"High-riding" superior pericardial recess in 62-year-old woman with bilateral pleural effusion. Contiguous CT scans (3-mm collimation) show 20-mm-diameter right paratracheal mass (arrows, A and B) with typical features of high-riding superior pericardial recess, including low-attenuation, connection with inferior portion of superior pericardial recess (arrowhead, C), and molded appearance. We saw no evidence of pericardial effusion on caudal scans (not shown).

View larger version (90K): [in a new window]   Fig. 3A. —"High-riding" superior pericardial recess in 67-year-old woman with history of right lower lobectomy for lung cancer. Preoperative CT scan (8-mm collimation) at level of great vessels shows low-attenuation lesion in right paratracheal region (arrow). Pathologic examination at time of surgery did not reveal metastases.

View larger version (61K): [in a new window]   Fig. 3B. —"High-riding" superior pericardial recess in 67-year-old woman with history of right lower lobectomy for lung cancer. Contiguous CT scans (8-mm collimation) obtained 2 years after surgery show slightly enlarged right paratracheal lesion (arrows, B), which was incorrectly presumed to be metastatic lymphadenopathy. Patient refused mediastinoscopy and received radiation therapy to area. Lesion had not changed in size on follow-up CT scans (not shown). In retrospect, lesion has typical features of high-riding superior pericardial recess including connection between high-riding (arrows, B) and inferior (arrowhead, C) portions of superior pericardial recess. Note also absence of pericardial effusion.

View larger version (69K): [in a new window]   Fig. 3C. —"High-riding" superior pericardial recess in 67-year-old woman with history of right lower lobectomy for lung cancer. Contiguous CT scans (8-mm collimation) obtained 2 years after surgery show slightly enlarged right paratracheal lesion (arrows, B), which was incorrectly presumed to be metastatic lymphadenopathy. Patient refused mediastinoscopy and received radiation therapy to area. Lesion had not changed in size on follow-up CT scans (not shown). In retrospect, lesion has typical features of high-riding superior pericardial recess including connection between high-riding (arrows, B) and inferior (arrowhead, C) portions of superior pericardial recess. Note also absence of pericardial effusion.

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