The pericardium is a conical, flask-like, fibroserous sac, in which contains the heart and the roots of the great vessels and defines the middle mediastinum.
Gross anatomy
The pericardium is made of two sacs in one. The outer sac is the fibrous pericardium and inner sac is the serous pericardium and they are divided by the pericardial space, which only contains 15-50 mL of serous fluid. They have quite different structures:
fibrous pericardium - tough connective tissue continuous with and bound to the central tendon of the diaphragm, the roots of the great vessels, the pretracheal layer of the deep cervical fascia and the sternum via the superior (to manubrium) and inferior sternopericardic ligaments (to xiphoid process)
serous pericardium - composed of a single layer of flattened cells forming a closed sac and forms two continuous layers:
visceral serous pericardium (or epicardium) - covers heart and great vessels
parietal serous pericardium - lines the fibrous pericardium
The serous pericardium is invaginated by the heart and great vessels forming two sinuses:
oblique sinus - formed by the superior and inferior vena cavae and the four pulmonary veins (blind-ending) and thus sits posterior to the left atrium
may be mistaken for oesophageal masses or bronchogenic cysts 3
transverse sinus - between the aorta and pulmonary artery in front and the atria behind and surrounds the ascending aorta
may be mistaken for dissection or lymphadenopathy 3
Relations
anteriorly - body of the sternum, cartilages of left third-to-seventh ribs, pleura and lungs, and thymus (in children)
posteriorly - oesophagus, descending thoracic aorta, pleura and lungs
laterally - pleura and lungs, phrenic nerves
Blood supply
internal thoracic artery and its musculophrenic branch
branches from the descending thoracic aorta
Nerve supply
vagus and phrenic nerves as well as the sympathetic trunks
Variant anatomy
pericardial agenesis
Radiographic appearance
CT
pericardium appears as a thin high-density line between the lower-density mediastinal and epicardial fat
fibrous and serous pericardium cannot be delineated and the upper limits of normal for pericardial thickness is 2mm 2
often not imaged over the left ventricle 3
MRI
T1WI and T2WI - appears as a low signal rim between the higher-signal mediastinal and epicardial fat 2-3
Gross anatomy
The pericardium is made of two sacs in one. The outer sac is the fibrous pericardium and inner sac is the serous pericardium and they are divided by the pericardial space, which only contains 15-50 mL of serous fluid. They have quite different structures:
fibrous pericardium - tough connective tissue continuous with and bound to the central tendon of the diaphragm, the roots of the great vessels, the pretracheal layer of the deep cervical fascia and the sternum via the superior (to manubrium) and inferior sternopericardic ligaments (to xiphoid process)
serous pericardium - composed of a single layer of flattened cells forming a closed sac and forms two continuous layers:
visceral serous pericardium (or epicardium) - covers heart and great vessels
parietal serous pericardium - lines the fibrous pericardium
The serous pericardium is invaginated by the heart and great vessels forming two sinuses:
oblique sinus - formed by the superior and inferior vena cavae and the four pulmonary veins (blind-ending) and thus sits posterior to the left atrium
may be mistaken for oesophageal masses or bronchogenic cysts 3
transverse sinus - between the aorta and pulmonary artery in front and the atria behind and surrounds the ascending aorta
may be mistaken for dissection or lymphadenopathy 3
Relations
anteriorly - body of the sternum, cartilages of left third-to-seventh ribs, pleura and lungs, and thymus (in children)
posteriorly - oesophagus, descending thoracic aorta, pleura and lungs
laterally - pleura and lungs, phrenic nerves
Blood supply
internal thoracic artery and its musculophrenic branch
branches from the descending thoracic aorta
Nerve supply
vagus and phrenic nerves as well as the sympathetic trunks
Variant anatomy
pericardial agenesis
Radiographic appearance
CT
pericardium appears as a thin high-density line between the lower-density mediastinal and epicardial fat
fibrous and serous pericardium cannot be delineated and the upper limits of normal for pericardial thickness is 2mm 2
often not imaged over the left ventricle 3
MRI
T1WI and T2WI - appears as a low signal rim between the higher-signal mediastinal and epicardial fat 2-3
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