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Updated: Jan 18, 2026
Anatomical Reconstructions of the Human Cardiac Venous System using Contrast-computed Tomography of Perfusion-fixed Specimens
Published on: April 18, 2013
Volume Rendering-Based Phrenic Nerve/Pericardiophrenic Bundle Identification Using Cardiac Computed Tomography
Daisetsu Aoyama1, Mark Rimmer1, Yuichiro Miyazaki1
1Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California-Los Angeles (UCLA), Los Angeles, California, USA.
Anatomy:
Phrenic nerves descend anterior to the pulmonary hila, sandwiched between the pericardium and parietal pleura, thus running extrinsically to the heart and lungs.
Pathology:
Phrenic nerve injury during catheter ablation or diaphragmatic stimulation during cardiac resynchronization therapy.
Imaging Correlation:
Conventional approach of preprocedural identification of the phrenic nerve includes slice-by-slice detection of the pericardiophrenic bundle using axial images. However, it is time-consuming with substantial uncertainty and difficulty in precise structural tracing in each axial plane. Three-dimensional visualization using a volume rendering technique has a distinct advantage for detecting fine structures and their anatomical course.
Treatment:
Preprocedural identification of the 3-dimensional course of the phrenic nerve in relation to surrounding structures is useful in avoiding iatrogenic injury of the phrenic nerve or predicting diaphragmatic stimulation.
Take-Home Message:
Volume rendering reconstruction offers fast and easy 3-dimensional identification of the phrenic nerve and is even feasible without a contrast material.
