Pericardial "Sleeve" Recess of Right Inferior Pulmonary Vein Mimicking Adenopathy: Computed Tomography Findings

Objective: The purpose of this study was to assess the computed tomography (CT) features of the pericardial "sleeve" recess of the right inferior pulmonary vein misinterpreted as adenopathy. Method: Six patients with fluid in the pericardial sleeve recess mistaken for adenopathy were retrospectively identified. The following CT features were assessed: location of fluid in relation to the vein, size, shape, attenuation, and mass effect on the inferior pulmonary vein. Results: The most common presentation was fluid inferior and posterior to the vein. The anterior and posterior components are typically spindle shaped, whereas the superior and inferior components are ovoid. The attenuation values of the fluid ranged from 2-32 H (mean = 13 H). None of the fluid collections exerted mass effect on the right inferior pulmonary vein. Conclusion: Although fluid in the right pulmonary venous sleeve pericardial recess can mimic adenopathy, this accumulation has a characteristic appearance, and knowledge of this normal variant is useful in preventing misinterpretation.