Lines & mediastinal stripes 01

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Right Paratracheal Stripe
Posterior wall of the bronchus intermedius
Left Paratracheal Stripe
Left subclavian artery border
Posterior-superior junction line

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  • A Diagnostic Approach
    to Mediastinal Abnormalities
    Camilla R. Whitten, MRCS, FRCR ● Sameer Khan, MRCP, FRCR
    Graham J. Munneke, MRCP, FRCR ● Sisa Grubnic, MRCP, FRCR
    http://radiographics.rsna.org/content/27/3/657.full?sid=b4229644-a916-4d4a-9f5a-1c4ca09125df#F1
  • Chest radiograph with superimposed mediastinal stripes. Yellow: right paratracheal stripe. Light blue: right and left paraspinal stripes. Red: azygoesophageal stripe. Brown: pleuroesophageal stripe. Purple: anterior junction line complex. Pink: left subclavian artery border. Light green: posterior-superior junction line. Dark green: para-aortic line.
  • The right parat racheal st ripe (open arrows) is composed
    of the right lateral t racheal wall, a small amount of mediast inal fat , parat racheal
    lymph nodes, and the visc eral and parietal pleural layers of the right upper lobe.

  • CT scan shows that the right paratracheal stripe (arrow) is formed by air within the right upper lobe and trachea outlining the right lateral tracheal wall, right upper lobe pleura, and intervening soft tissues.
  • Abnormal right paratracheal stripe caused by a large ectopic parathyroid adenoma in a 52-year-old man. (a) Frontal chest radiograph demonstrates widening of the right paratracheal stripe (arrow).
  • CT scan helps confirm a large right paratracheal mass (arrow) with diffuse osteopenia from primary hyperparathyroidism.
  • CT scan helps confirm a large right paratracheal mass (arrow) with diffuse osteopenia from primary hyperparathyroidism.
  • CT scan helps confirm a large right paratracheal mass (arrow) with diffuse osteopenia from primary hyperparathyroidism.
  • CT scan helps confirm a large right paratracheal mass (arrow) with diffuse osteopenia from primary hyperparathyroidism.
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • The posterior wall of the bronchus intermedius also appears as a stripe on lateral chest radiographs and is important in evaluating mediastinal disease. After the takeoff of the right upper lobe bronchus, the bronchus intermedius continues to descend for approximately 3–4 cm. The stripe representing the posterior wall of the bronchus intermedius is formed when lung within the azygo-esophageal recess outlines this posterior wall (11). This stripe is present on approximately 90%–95% of lateral chest radiographs and appears as a thin, vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus
  • Normally, the posterior wall of the bronchus intermedius measures between 0.5 and 3.0 mm in thickness 
  • Normally, the posterior wall of the bronchus intermedius measures between 0.5 and 3.0 mm in thickness 
  • The left paratracheal stripe is formed by contact between the left upper lobe and either the mediastinal fat adjacent to the left tracheal wall or the left tracheal wall itself. Air within the trachea outlines the intervening soft tissues, thereby forming the left paratracheal stripe. The stripe extends superiorly from the aortic arch to join with the reflection from the left subclavian artery and thus may be referred to as the left paratracheal reflection

  • The left paratracheal stripe is formed by contact between the left upper lobe and either the mediastinal fat adjacent to the left tracheal wall or the left tracheal wall itself. Air within the trachea outlines the intervening soft tissues, thereby forming the left paratracheal stripe. The stripe extends superiorly from the aortic arch to join with the reflection from the left subclavian artery and thus may be referred to as the left paratracheal reflection

  • Visible on 21%–31% of posteroanterior chest radiographs, the left paratracheal stripe is seen less frequently than the right paratracheal stripe, since it may be obscured by contact between the left lung and either the proximal left common carotid artery anteriorly or the left subclavian artery posteriorly
  • Visible on 21%–31% of posteroanterior chest radiographs, the left paratracheal stripe is seen less frequently than the right paratracheal stripe, since it may be obscured by contact between the left lung and either the proximal left common carotid artery anteriorly or the left subclavian artery posteriorly
  • Visible on 21%–31% of posteroanterior chest radiographs, the left paratracheal stripe is seen less frequently than the right paratracheal stripe, since it may be obscured by contact between the left lung and either the proximal left common carotid artery anteriorly or the left subclavian artery posteriorly
  • Abnormal-appearing left paratracheal stripe in a 47-year-old patient with metastatic thyroid carcinoma. (a) Frontal chest radiograph demonstrates widening of the left paratracheal stripe (arrows) with mass effect on the trachea
  • Abnormal-appearing left paratracheal stripe in a 47-year-old patient with metastatic thyroid carcinoma. (a) Frontal chest radiograph demonstrates widening of the left paratracheal stripe (arrows) with mass effect on the trachea
  • Abnormal-appearing left paratracheal stripe in a 47-year-old patient with metastatic thyroid carcinoma. (a) Frontal chest radiograph demonstrates widening of the left paratracheal stripe (arrows) with mass effect on the trachea
  • Chest radiograph with superimposed mediastinal stripes. Yellow: right paratracheal stripe. Light blue: right and left paraspinal stripes. Red: azygoesophageal stripe. Brown: pleuroesophageal stripe. Purple: anterior junction line complex. Pink: left subclavian artery border. Light green: posterior-superior junction line. Dark green: para-aortic line.
  • Chest radiograph with superimposed mediastinal stripes. Yellow: right paratracheal stripe. Light blue: right and left paraspinal stripes. Red: azygoesophageal stripe. Brown: pleuroesophageal stripe. Purple: anterior junction line complex. Pink: left subclavian artery border. Light green: posterior-superior junction line. Dark green: para-aortic line.
  • Collimated posteroanterior chest radiograph shows the posterior junction line (arrow) projecting through the tracheal air column.
  • Posterior junction line on PA chest radiograph
    (arrows). Note that the line extends above the level of the clavic les.
  • CT scan shows the posterior junction line (arrow), which is formed by the interface between the lungs posterior to the mediastinum and consists of four pleural layers.
  • A. A posteroanterior chest
    f ilm shows both anterior (solid arrows) and posterior (open arrows) junc t ion lines.
    B. CT through the upper thorax in another pat ient shows the anterior junc t ion line in
    the retrosternal space, while the posterior junc t ion line lies in the ret rot racheal
    space.
  • A. A posteroanterior chest
    f ilm shows both anterior (solid arrows) and posterior (open arrows) junc t ion lines.
    B. CT through the upper thorax in another pat ient shows the anterior junc t ion line in
    the retrosternal space, while the posterior junc t ion line lies in the ret rot racheal
    space.
  •  Bronchogenic cyst.(a) Posteroanterior chest radiograph shows a mass (arrow) obliterating the posterior junction line. Note that the mass extends above the level of the clavicle and has a well-demarcated outline due to the interface with adjacent lung (arrowhead).
  •  Bronchogenic cyst.(a) Posteroanterior chest radiograph shows a mass (arrow) obliterating the posterior junction line. Note that the mass extends above the level of the clavicle and has a well-demarcated outline due to the interface with adjacent lung (arrowhead).
  •  Bronchogenic cyst.(a) Posteroanterior chest radiograph shows a mass (arrow) obliterating the posterior junction line. Note that the mass extends above the level of the clavicle and has a well-demarcated outline due to the interface with adjacent lung (arrowhead).
  •  Bronchogenic cyst.(a) Posteroanterior chest radiograph shows a mass (arrow) obliterating the posterior junction line. Note that the mass extends above the level of the clavicle and has a well-demarcated outline due to the interface with adjacent lung (arrowhead).
  • Lines & mediastinal stripes 01

    1. 1. Dr Mazen Qusaibaty MD, DIS Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health Email: Qusaibaty@gmail.com Lines & mediastinal Stripes - 01
    2. 2. Topic Outline 2 1. Right Paratracheal Stripe 2. Posterior wall of the bronchus intermedius 3. Left Paratracheal Stripe 4. Left subclavian artery border 5. Posterior-superior junction line
    3. 3. • Right paratracheal stripe 3
    4. 4. Chest radiograph with superimposed mediastinal stripes Yellow • Right paratracheal stripe 4
    5. 5. The right paratracheal stripe (open arrows) is composed Of: Right lateral tracheal wall Small amount of mediastinal fat Paratracheal lymph nodes Visceral and parietal pleural layers of the right upper lobe 5
    6. 6. Right paratracheal stripe 6
    7. 7. PA chest x ray widening of the right paratracheal stripe (arrow) Abnormal right paratracheal stripe caused by a large ectopic parathyroid adenoma in a 52-year-old man7
    8. 8. CT scan helps confirm a large right paratracheal mass (arrow) 8
    9. 9. Guess the effect of this mass please !! 9
    10. 10. A. Anemia B. Dysphonia. C. Dysphasia. D. Primary hyperparathyroidism 10
    11. 11. WHY ? Diffuse osteopenia from primary hyperparathyroidism. 11
    12. 12. Quiz : long solid arrow is : A. The right paratracheal stripe B. The pulmonary artery C. Anterior junction line complex D. The pulmonary veins E. The posterior wall of the bronchus intermedius
    13. 13. Quiz : long solid arrow is : A. The right paratracheal stripe B. The pulmonary artery C. Anterior junction line complex D. The pulmonary veins E. The posterior wall of the bronchus intermedius
    14. 14. 14
    15. 15. Posterior Wall Of The Bronchus Intermedius • Appears as a stripe 15
    16. 16. Posterior Wall Of The Bronchus Intermedius • Appears on lateral chest radiographs 16
    17. 17. Posterior Wall Of The Bronchus Intermedius • It is important in evaluating mediastinal disease 17
    18. 18. Posterior Wall Of The Bronchus Intermedius • The stripe representing the posterior wall of the bronchus intermedius 18
    19. 19. The posterior wall of the bronchus intermedius is formed when • Lung + Azygo- esophageal recess outlines this posterior wall 19
    20. 20. Posterior Wall Of The Bronchus Intermedius • Appears as A thin Vertical or slightly oblique stripe that typically projects through the radiolucent area created by the left upper lobe bronchus 20
    21. 21. Posterior Wall Of The Bronchus Intermedius • This stripe is present on approximately 90%–95% of lateral chest radiographs 21
    22. 22. Normal thickness Posterior Wall Of The Bronchus Intermedius • Measures between 0.5 and 3.0 mm in thickness 22
    23. 23. Abnormal thickening of the posterior wall of the bronchus intermedius • Cardiogenic pulmonary edema23
    24. 24. Abnormal thickening of the posterior wall of the bronchus intermedius Primary lung carcinoma Lymphadenopathy Lymphoma Metastatic disease Tuberculosis Sarcoidosis 24 SchnurMJ, Winkler B, Austin JH. Thickening of the posterior wall of the bronchus intermedius. Radiology1981; 139: 551–559.
    25. 25. 25 Left Paratracheal Stripe
    26. 26. Left Paratracheal Stripe is formed by contact between Left upper lobe Mediastinal fat Or left Tracheal wall 26
    27. 27. Left Paratracheal Stripe The stripe is extending superiorly from the aortic arch To join with the reflection from the left subclavian artery superiorly 27
    28. 28. Teaching Point / Left Paratracheal Stripe • Visible on 21%–31% of PA chest radiographs 28
    29. 29. Teaching Point / Left Paratracheal Stripe 29
    30. 30. Teaching Point / Left Paratracheal Stripe • The proximal left common carotid artery anteriorly • Or the left subclavian artery posteriorly It may be obscured by contact between the left lung and either 30
    31. 31. Widening of Left Paratracheal Stripe Large left-sided pleural effusions Left paratracheal lymphadenopathy Neoplasm Mediastinal hematoma 31 WoodringJH, Daniel TL. Mediastinal analysis emphasizing plain radiographs and computed tomograms. Med Radiogr Photogr1986; 62:1–48.
    32. 32. PA Chest x Ray Widening of the left paratracheal stripe (arrows) with mass effect on the trachea 32
    33. 33. Abnormal-appearing left paratracheal stripe A 47-year-old patient with metastatic thyroid carcinoma 33
    34. 34. CT scan reveals a large thyroid mass (arrow) Supraclavicular lymphadenopathy * 34
    35. 35. Chest radiograph with superimposed mediastinal stripes Pink • Left subclavian artery border 35
    36. 36. Normal chest x ray Left subclavian artery 36
    37. 37. Left subclavian artery • Aorta Angiogram 37
    38. 38. Left subclavian artery / Angiogram • Origin of subclavian 38
    39. 39. Left subclavian artery / Angiogram • Branches of subclavian artery 39
    40. 40. Thoracic CT scan Left subclavian artery 40
    41. 41. Thoracic CT scan Left subclavian artery 41
    42. 42. Thoracic CT scan Left subclavian artery 42
    43. 43. Posterior-superior junction line 43
    44. 44. Chest radiograph with superimposed mediastinal stripes Light green • Posterior- superior junction line 44
    45. 45. PA chest X ray shows the posterior junction line (arrow) Projecting through the tracheal air column 45
    46. 46. PA chest X ray shows the posterior junction line (arrow) Note that the line extends above the level of the clavicles. 46
    47. 47. CT scan shows the posterior junction line • which is formed by: The interface between the lungs posterior to the mediastinum Consists of four pleural layers 47
    48. 48. Anterior and Posterior Junction Lines • Anterior junction line (retrosternal space) • Posterior Junction lines (retrotracheal space) 48
    49. 49. PA chest X ray shows a mass (arrow) obliterating the posterior junction line Note that the mass extends above the level of the clavicle 50
    50. 50. PA chest X ray shows a mass (arrow) obliterating the posterior junction line • The mass has a well- demarcated outline due to the interface with adjacent lung (arrowhead) 51
    51. 51. Can you guess the diagnosis ? A. Bronchogenic cyst B. Lymphoma C. Thymoma D. Teratoma E. Thyroid enlargement
    52. 52. Can you guess the diagnosis ? A. Bronchogenic cyst B. Lymphoma C. Thymoma D. Teratoma E. Thyroid enlargement
    53. 53. 54

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