High-riding Superior Pericardial Recess: A Key Pitfall in Misinterpretation During CT Evaluation of the Mediastinum.

An understanding of thoracic computed tomographic anatomy is vital for procedural planning in bronchoscopy. When reviewing computed tomographic images in preparation for endobronchial ultrasound-directed staging for lung cancer, the presence of fluid in pericardial recesses can often be mistaken for mediastinal lymphadenopathy, potentially causing pitfalls in radiologic interpretation. We describe 2 cases of a high-riding superior aortic recess extending into right paratracheal lymph node station mimicking paratracheal lymphadenopathy. We review the anatomy and imaging characteristics of pericardial recesses with emphasis on differentiating these findings from mediastinal lymphadenopathy.