The superior sinus of the pericardium: CT appearance.

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Abstract
On computed tomography [CT], a mass-like density is often observed, just posterior to the ascending aorta, that occasionally has been mistaken for mediastinal lymph node enlargement. Cadaver studies [human] confirmed this retroaortic structure to be an extension of the pericardial cavity, the superior sinus. Current anatomic texts sometimes depict this space without description. Anatomic studies revealed the presence of a superior sinus in all of the 28 cadavers studied. The mean cross-sectional diameter of the sinus in a coronal plane was 2.5 cm with a range from 1.2 to 3.8 cm. Retrospective review of 116 consecutive adult chest computed tomographic examinations disclosed its presence in 49%. In 15% of the total, the size of the sinus was sufficiently large potentially to simulate mediastinal lymphadenopathy. This normal variant has a characteristic location, shape, and attenuation value by CT that should allow recognition and prevent misinterpretation.

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