Normal Pericardial Anatomy - II

A and B. Right lateral view of the pericardium shows the right phrenic nerve (arrows). It courses parallel and lateral to the superior vena cava and continues downward, anterior to the right pulmonary hilum, towards the diaphragm. C and D. Left lateral view shows the left phrenic nerve (arrows) descending over the left atrial appendage and anterolateral left ventricle before reaching the diaphragm.

Note the relationship of the pathway of the phrenic nerve intersecting with the path of some of the coronary arteries and veins visible through the translucent myocardium. This path can allow pacing devices deployed in the coronary veins to stimulate the phrenic nerve as well, which is an undesirable effect.

The images below show another example of the phrenic nerve and accompanying vessels.

Right lateral view of the heart and pericardium. The right phrenic nerve and pericardiophrenic vessels lie between the parietal pericardium and mediastinal pleura anterior to the pulmonary hilum. The arrowheads highlight these structures. Note he abundant adipose tissue covering the mediastinal surface of the pericardium in the anterior and lateral surfaces.

RIPV = right inferior pulmonary vein. RPA = right pulmonary artery. RSPV = right superior pulmonary vein. SVC = Superior vena cava.

Left lateral view of the heart and pericardium. The course of the left phrenic nerve and accompanying vessels are highlighted by the arrowheads.

Ao = aorta. LIPV = Left inferior pulmonary vein. LPA = Left pulmonary artery. LSPV = Left superior pulmonary vein.

The close relationship between the parietal (fibrous) pericardium and visceral pericardium as well as the pericardial space are shown here.

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