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Superior sternopericardial ligaments

The superior sternopericardial ligaments are fibrous connective tissue bands that extend from the fibrous pericardium to the posterior surface of the manubrium of the sternum. These ligaments act as stabilizing structures, anchoring the pericardium and the heart within the superior anterior mediastinum, thereby preventing excessive displacement during cardiac motion or changes in intrathoracic pressure. They are part of the sternopericardial ligament complex, which includes both superior and inferior components.

Synonyms

  • Upper sternopericardial ligaments

  • Superior pericardial–sternal ligaments

  • Fibrous pericardial attachments to sternum

Function

  • Stabilizes the fibrous pericardium by anchoring it to the sternum

  • Limits excessive anteroposterior displacement of the heart

  • Maintains the central position of the heart within the mediastinum

  • Contributes to fixation of the pericardium during respiration and cardiac motion

MRI Appearance

T1-weighted images:

  • Appear as thin, low signal intensity linear bands connecting pericardium to sternum

  • Surrounded by high signal anterior mediastinal fat, improving contrast

  • May be subtle unless thickened or involved in disease

T2-weighted images:

  • Ligaments remain low signal intensity

  • Adjacent fluid (pericardial effusion, mediastinal edema) is hyperintense, outlining them better

  • Pathology such as fibrosis or inflammation may alter signal or thickness

STIR (Short Tau Inversion Recovery):

  • Fat suppression makes ligaments appear as hypointense linear bands

  • Surrounding inflammation, edema, or effusion appears bright hyperintense

T1 Post-Contrast (Gadolinium-enhanced):

  • Normal ligaments show minimal or no enhancement

  • Enhancement may occur with pericarditis, mediastinitis, or fibrosis

CT Appearance

Non-contrast CT:

  • Seen as thin fibrous soft-tissue bands between the sternum and anterior pericardium

  • May be difficult to detect unless calcified or thickened

Contrast-enhanced CT (CECT):

  • Ligaments remain as non-enhancing linear structures against enhancing pericardium or adjacent mediastinal vessels

  • Helpful for detecting fibrosis or abnormal pericardial attachment

CT Lung Window:

  • Ligaments appear as thin soft-tissue linear densities in the anterior mediastinum against the background of low-attenuation lungs

  • Best appreciated when mediastinal fat is preserved, creating contrast

  • Useful for detecting abnormal thickening, calcification, or post-inflammatory changes that may not be as apparent on mediastinal windows

CT image

Superior sternopericardial ligaments anatomy CT axial image -img-00000-00000