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DOI: 10.1148/rg.271065089
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Lesions of the Cardiophrenic Space: Findings at Cross-sectional Imaging1

Víctor Pineda, MD, Jordi Andreu, MD, José Cáceres, MD, Xavier Merino, MD, Diego Varona, MD and Rosa Domínguez-Oronoz, MD

1 From the Department of Radiology, Hospital General Vall d’Hebron, Universitat Autónoma de Barcelona, Pg De la Vall d’Hebron 119–129, 08035 Barcelona, Spain. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received May 4, 2006; revision requested June 29 and received August 21; accepted August 22. All authors have no financial relationships to disclose.

Figure 1
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  		Figure 1a.  Frontal view (a) and sagittal view (b) of the parasternal region show the normal anatomy of the cardiophrenic space.

 

Figure 1
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  		Figure 1b.  Frontal view (a) and sagittal view (b) of the parasternal region show the normal anatomy of the cardiophrenic space.

 

Figure 2
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  		Figure 2.  Axial CT scan shows the normal pericardium (arrow) separating the pericardial fat (*) from the epicardial fat (+).

 

Figure 3
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  		Figure 3a.  Effect of body habitus on the amount of pericardial fat. Coronal T2-weighted MR images show less cardiophrenic fat in a thin person (a) than in an overweight person (b).

 

Figure 3
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  		Figure 3b.  Effect of body habitus on the amount of pericardial fat. Coronal T2-weighted MR images show less cardiophrenic fat in a thin person (a) than in an overweight person (b).

 

Figure 4
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  		Figure 4a.  Large fat pad. (a) Posteroanterior chest radiograph shows pericardial fat simulating a cardiophrenic mass (arrows). (b) Axial CT scan shows the large cardiophrenic fat pad (arrows).

 

Figure 4
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  		Figure 4b.  Large fat pad. (a) Posteroanterior chest radiograph shows pericardial fat simulating a cardiophrenic mass (arrows). (b) Axial CT scan shows the large cardiophrenic fat pad (arrows).

 

Figure 5
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  		Figure 5a.  Morgagni hernia. (a) Axial T1-weighted MR image shows a fatty component (arrow) and herniated intestine (arrowhead) in the cardiophrenic space. (b) Coronal view shows the intestine herniated through the Morgagni foramen (arrow).

 

Figure 5
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  		Figure 5b.  Morgagni hernia. (a) Axial T1-weighted MR image shows a fatty component (arrow) and herniated intestine (arrowhead) in the cardiophrenic space. (b) Coronal view shows the intestine herniated through the Morgagni foramen (arrow).

 

Figure 6
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  		Figure 6a.  Morgagni hernia. (a) Axial CT scan shows an air-containing mass (arrowhead). (b) Sagittal reformatted view shows a diaphragmatic defect (arrows) and the herniated intestine.

 

Figure 6
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  		Figure 6b.  Morgagni hernia. (a) Axial CT scan shows an air-containing mass (arrowhead). (b) Sagittal reformatted view shows a diaphragmatic defect (arrows) and the herniated intestine.

 

Figure 7
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  		Figure 7a.  Morgagni hernia and associated peritoneal carcinomatosis in a 55-year-old man. (a) CT scan shows a well-defined fatty mass with marked omental vessels and fatty infiltration. (b) On an axial CT scan obtained 10 months later, the hernia has shrunk and the attenuation has increased. These findings are secondary to abdominal ascites and chemotherapy.

 

Figure 7
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  		Figure 7b.  Morgagni hernia and associated peritoneal carcinomatosis in a 55-year-old man. (a) CT scan shows a well-defined fatty mass with marked omental vessels and fatty infiltration. (b) On an axial CT scan obtained 10 months later, the hernia has shrunk and the attenuation has increased. These findings are secondary to abdominal ascites and chemotherapy.

 

Figure 8
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  		Figure 8a.  Pericardial fat necrosis in a 58-year-old woman. (a) Posteroanterior chest radiograph shows an area of increased opacity in the left paracardiac region (arrow). (b) Axial CT scan shows an encapsulated fatty lesion with mild stranding in the left cardiophrenic space (arrow). Arrowhead = associated local pericardial thickening. (c) On a chest radiograph obtained 3 months later, the paracardiac area of increased opacity has disappeared. (d) Follow-up axial CT scan shows a marked decrease in the size of the lesion (arrow).

 

Figure 8
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  		Figure 8b.  Pericardial fat necrosis in a 58-year-old woman. (a) Posteroanterior chest radiograph shows an area of increased opacity in the left paracardiac region (arrow). (b) Axial CT scan shows an encapsulated fatty lesion with mild stranding in the left cardiophrenic space (arrow). Arrowhead = associated local pericardial thickening. (c) On a chest radiograph obtained 3 months later, the paracardiac area of increased opacity has disappeared. (d) Follow-up axial CT scan shows a marked decrease in the size of the lesion (arrow).

 

Figure 8
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  		Figure 8c.  Pericardial fat necrosis in a 58-year-old woman. (a) Posteroanterior chest radiograph shows an area of increased opacity in the left paracardiac region (arrow). (b) Axial CT scan shows an encapsulated fatty lesion with mild stranding in the left cardiophrenic space (arrow). Arrowhead = associated local pericardial thickening. (c) On a chest radiograph obtained 3 months later, the paracardiac area of increased opacity has disappeared. (d) Follow-up axial CT scan shows a marked decrease in the size of the lesion (arrow).

 

Figure 8
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  		Figure 8d.  Pericardial fat necrosis in a 58-year-old woman. (a) Posteroanterior chest radiograph shows an area of increased opacity in the left paracardiac region (arrow). (b) Axial CT scan shows an encapsulated fatty lesion with mild stranding in the left cardiophrenic space (arrow). Arrowhead = associated local pericardial thickening. (c) On a chest radiograph obtained 3 months later, the paracardiac area of increased opacity has disappeared. (d) Follow-up axial CT scan shows a marked decrease in the size of the lesion (arrow).

 

Figure 9
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  		Figure 9a.  Thymolipoma. (a) Axial CT scan shows a large fatty mass that wraps around the heart. (b) Axial CT scan obtained cranially to a shows that the mass originates in the anterior superior mediastinum.

 

Figure 9
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  		Figure 9b.  Thymolipoma. (a) Axial CT scan shows a large fatty mass that wraps around the heart. (b) Axial CT scan obtained cranially to a shows that the mass originates in the anterior superior mediastinum.

 

Figure 10
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  		Figure 10a.  Pleuropericardial cyst in a 43-year-old man. (a) Frontal radiograph shows an oval mass that obscures the cardiophrenic angle (arrow). (b) Axial unenhanced CT scan shows the thin-walled, sharply defined, oval, homogeneous mass; its attenuation is near that of water. (c) Follow-up unenhanced CT scan shows a decrease in the size of the lesion, a finding that occasionally occurs with pericardial cysts.

 

Figure 10
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  		Figure 10b.  Pleuropericardial cyst in a 43-year-old man. (a) Frontal radiograph shows an oval mass that obscures the cardiophrenic angle (arrow). (b) Axial unenhanced CT scan shows the thin-walled, sharply defined, oval, homogeneous mass; its attenuation is near that of water. (c) Follow-up unenhanced CT scan shows a decrease in the size of the lesion, a finding that occasionally occurs with pericardial cysts.

 

Figure 10
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  		Figure 10c.  Pleuropericardial cyst in a 43-year-old man. (a) Frontal radiograph shows an oval mass that obscures the cardiophrenic angle (arrow). (b) Axial unenhanced CT scan shows the thin-walled, sharply defined, oval, homogeneous mass; its attenuation is near that of water. (c) Follow-up unenhanced CT scan shows a decrease in the size of the lesion, a finding that occasionally occurs with pericardial cysts.

 

Figure 11
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  		Figure 11a.  Herniated hydatid cyst in a 51-year-old woman. (a) Frontal radiograph shows an area of increased opacity in the right paracardiac region (arrow). (b) Axial T2-weighted MR image shows a well-defined lesion with a partially calcified wall (arrows) and smaller cystic lesions within it (arrowheads). (c) Image obtained caudally to b shows a large hydatid cyst in the liver.

 

Figure 11
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  		Figure 11b.  Herniated hydatid cyst in a 51-year-old woman. (a) Frontal radiograph shows an area of increased opacity in the right paracardiac region (arrow). (b) Axial T2-weighted MR image shows a well-defined lesion with a partially calcified wall (arrows) and smaller cystic lesions within it (arrowheads). (c) Image obtained caudally to b shows a large hydatid cyst in the liver.

 

Figure 11
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  		Figure 11c.  Herniated hydatid cyst in a 51-year-old woman. (a) Frontal radiograph shows an area of increased opacity in the right paracardiac region (arrow). (b) Axial T2-weighted MR image shows a well-defined lesion with a partially calcified wall (arrows) and smaller cystic lesions within it (arrowheads). (c) Image obtained caudally to b shows a large hydatid cyst in the liver.

 

Figure 12
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  		Figure 12a.  Lymphadenopathy in a 58-year-old woman with ovarian carcinoma. (a) CT scan shows a meta-static lymph node in the right cardiophrenic space (arrow). (b) Pelvic axial CT scan shows a metastatic implant in the pouch of Douglas (arrow).

 

Figure 12
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  		Figure 12b.  Lymphadenopathy in a 58-year-old woman with ovarian carcinoma. (a) CT scan shows a meta-static lymph node in the right cardiophrenic space (arrow). (b) Pelvic axial CT scan shows a metastatic implant in the pouch of Douglas (arrow).

 

Figure 13
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  		Figure 13a.  Lymphadenopathy in a 49-year-old man with lymphoma. (a) Axial CT scan shows a lymph node (arrow) in the right cardiophrenic space. Note the associated pericardial and pleural effusions. (b) Axial maximum intensity projection image shows huge abdominal masses surrounding the vessels.

 

Figure 13
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  		Figure 13b.  Lymphadenopathy in a 49-year-old man with lymphoma. (a) Axial CT scan shows a lymph node (arrow) in the right cardiophrenic space. Note the associated pericardial and pleural effusions. (b) Axial maximum intensity projection image shows huge abdominal masses surrounding the vessels.

 

Figure 14
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  		Figure 14.  Axial MR image shows an incidentally found normal lymph node (arrow) within the pericardial fat.

 

Figure 15
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  		Figure 15.  Lymphadenopathy in a 62-year-old woman who was previously treated for carcinoma of the left breast. Axial contrast-enhanced CT scan shows a metastatic lymph node in the mammary chain (arrow).

 

Figure 16
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  		Figure 16.  Lymphadenopathy in a 53-year-old man with pleural mesothelioma. CT scan shows metastatic lymph nodes in the cardiophrenic space (arrowheads). Note the pleural thickening (open arrows). Also note the pleural calcifications in the right major fissure (solid arrow), which are due to previous asbestos exposure.

 

Figure 17
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  		Figure 17a.  Lymphadenopathy in a patient with peripheral cholangiocarcinoma. (a) Axial CT scan shows lymph nodes in the cardiophrenic space (arrow). (b) Axial CT scan obtained caudally to a shows the peripheral cholangiocarcinoma in the left hepatic lobe (arrow).

 

Figure 17
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  		Figure 17b.  Lymphadenopathy in a patient with peripheral cholangiocarcinoma. (a) Axial CT scan shows lymph nodes in the cardiophrenic space (arrow). (b) Axial CT scan obtained caudally to a shows the peripheral cholangiocarcinoma in the left hepatic lobe (arrow).

 

Figure 18
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  		Figure 18a.  Thymoma in a 34-year-old man. (a) Axial contrast-enhanced CT scan shows a well-defined mass of soft-tissue attenuation in the anterior mediastinum (arrow). Note the adjacent compressed lung (arrowhead). (b) Axial contrast-enhanced CT scan obtained cranially to a shows that the mass has a superior origin in the lower thymic region (arrow).

 

Figure 18
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  		Figure 18b.  Thymoma in a 34-year-old man. (a) Axial contrast-enhanced CT scan shows a well-defined mass of soft-tissue attenuation in the anterior mediastinum (arrow). Note the adjacent compressed lung (arrowhead). (b) Axial contrast-enhanced CT scan obtained cranially to a shows that the mass has a superior origin in the lower thymic region (arrow).

 

Figure 19
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  		Figure 19.  Colonic interposition in a patient who was treated for esophageal cancer. Axial CT scan shows postoperative changes related to interposition of the colon (arrow).

 

Figure 20
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  		Figure 20a.  Varices in a patient with hepatic cirrhosis. (a) Contrast-enhanced CT scan shows varices in the right cardiophrenic space (arrow), which simulate lymph nodes. (b) Axial CT scan obtained caudally to a shows the varices (arrows) arising from the abdomen.

 

Figure 20
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  		Figure 20b.  Varices in a patient with hepatic cirrhosis. (a) Contrast-enhanced CT scan shows varices in the right cardiophrenic space (arrow), which simulate lymph nodes. (b) Axial CT scan obtained caudally to a shows the varices (arrows) arising from the abdomen.

 

Figure 21
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  		Figure 21a.  Cardiophrenic varices in a 58-year-old woman with thrombosis of the superior vena cava who previously underwent surgery for breast cancer. (a) Axial CT scan shows cardiophrenic varices (straight arrows) and a communicating subcutaneous vein (curved arrow). Note the ectasia of the azygos veins (arrowheads). (b) Axial CT scan obtained cranially to a shows a catheter (arrow) in the thrombosed superior vena cava.

 

Figure 21
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  		Figure 21b.  Cardiophrenic varices in a 58-year-old woman with thrombosis of the superior vena cava who previously underwent surgery for breast cancer. (a) Axial CT scan shows cardiophrenic varices (straight arrows) and a communicating subcutaneous vein (curved arrow). Note the ectasia of the azygos veins (arrowheads). (b) Axial CT scan obtained cranially to a shows a catheter (arrow) in the thrombosed superior vena cava.

 




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