High Riding Pericardial Recess

Abstract

We report for the first time 2 cases of right paratracheal pericardial recess cysts identified by endobronchial ultrasound (EBUS) and subsequently aspirated by transbronchial needle aspiration. High riding pericardial cyst is a recently identified radiologic entity, which can mimic a right paratracheal lymph node. EBUS transbronchial needle aspiration is often performed in this site to aspirate tissue for pathologic diagnosis. On ultrasound, cystic structures appear black as do blood vessels. Although there are other features to identify blood vessels on ultrasound, it can be disconcerting to initially see a black lesion where the proceduralist was expecting to see a lymph node. The EBUS appearances are described, showing a cystic lesion above the azygous vein and medial to the superior vena cava. The use of color Doppler by EBUS was particularly useful in confirming the presence of a cystic structure as opposed to a blood vessel in this location.