The costomediastinal recess is the pleural fold where the costal and mediastinal pleurae meet at the anterior mediastinum. It is smaller than the costodiaphragmatic recess and becomes relevant in anterior mediastinal masses and substernal thyroid.
The costomediastinal recess is entered during median sternotomy and anterior thoracotomy. Pleural effusion may extend into this recess producing a paracardiac opacity on chest X-ray. The recess is relevant in thoracoscopic pericardial window creation at the anterior mediastinum.
Pleural fluid accumulation in the costomediastinal recess producing a paracardiac density on chest X-ray, potentially obscuring the cardiac border and mimicking pericardial effusion.
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