The oblique pericardial sinus is a cul-de-sac in the posterior pericardial sac, bounded by the pulmonary veins and the inferior vena cava, forming a blind pouch behind the left atrium. It is a bursa-like synovial space that accommodates fluid.
The oblique pericardial sinus is the only non-accessible component of the pericardial cavity from the standard anterior approach — it cannot be drained transxiphoid. Post-operative pericardial effusions may loculate in this sinus, requiring echo guidance or CT to identify and drain posteriorly. It is the space developed in posterior pericardiotomy.
Isolated fluid collection in the oblique pericardial sinus not accessible to standard transxiphoid drainage, requiring posterior surgical or CT-guided approach.
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