The oblique pericardial sinus is the posterior pericardial recess behind the left atrium, bounded by the four pulmonary veins and inferior vena cava. It is a blind pouch not communicating with the transverse sinus and is the site of loculated post-operative pericardial effusions.
The oblique sinus is a key anatomical space in cardiac surgery, relevant in total cavopulmonary connection (Fontan) repair and posterior pericardiotomy for drainage. It cannot be accessed from the anterior transxiphoid approach. On cross-sectional imaging the oblique sinus appears as a C-shaped fluid collection posterior to the left atrium.
Post-cardiac surgery blood collection loculated in the oblique pericardial sinus producing delayed tamponade physiology, requiring posterior drainage via video-assisted thoracoscopy.
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