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Lines & mediastinal stripes 01

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Right Paratracheal Stripe

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

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    Lines & mediastinal stripes 01 Lines & mediastinal stripes 01 Presentation Transcript

    • Lines & mediastinal Stripes - 01
      Dr Mazen Qusaibaty
      MD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian health
      Email: Qusaibaty@gmail.com
    • Topic Outline
      2
      RightParatrachealStripe
      Posterior wall of the bronchus intermedius
      Left Paratracheal Stripe
      Left subclavian artery border
      Posterior-superior junction line
    • Rightparatrachealstripe
      3
    • Chest radiograph with superimposed mediastinal stripes
      4
    • 5
    • Rightparatrachealstripe
      6
    • 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 man
      7
    • CT scan helps confirm a large right paratracheal mass (arrow)
      8
    • Guess the effect of this mass please !!
      9
    • Anemia
      Dysphonia.
      Dysphasia.
      Primary hyperparathyroidism
      10
    • WHY ?
      Diffuse osteopenia from primary hyperparathyroidism.
      11
    • Quiz : long solid arrow is :
      The right paratracheal stripe
      The pulmonary artery
      Anterior junction line complex
      The pulmonary veins
      The posterior wall of the bronchus intermedius
    • Quiz : long solid arrow is :
      The right paratracheal stripe
      The pulmonary artery
      Anterior junction line complex
      The pulmonary veins
      The posterior wall of the bronchus intermedius
    • Posterior wall of the Bronchus Intermedius
      14
    • Posterior Wall Of The Bronchus Intermedius
      Appears as a stripe
      15
    • Posterior Wall Of The Bronchus Intermedius
      Appears on lateral chest radiographs
      16
    • Posterior Wall Of The Bronchus Intermedius
      It is important in evaluating mediastinal disease
      17
    • Posterior Wall Of The Bronchus Intermedius
      The stripe representing the posterior wall of the bronchus intermedius
      18
    • The posterior wall of the bronchus intermedius is formed when
      Lung + Azygo-esophageal recess outlines this posterior wall
      19
    • 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
    • Posterior Wall Of The Bronchus Intermedius
      This stripe is present on approximately 90%–95% of lateral chest radiographs
      21
    • Normal thickness Posterior Wall Of The Bronchus Intermedius
      Measures between 0.5 and 3.0 mm in thickness 
      22
    • Abnormal thickening of the posterior wall of the bronchus intermedius
      Cardiogenic pulmonary edema
      23
    • 24
      SchnurMJ, Winkler B, Austin JH. Thickening of the posterior wall of the bronchus intermedius. Radiology1981; 139: 551–559.
    • 25
    • Left Paratracheal Stripe is formed by contact between
      26
    • Left Paratracheal Stripe
      27
    • Teaching Point / Left Paratracheal Stripe
      Visible on 21%–31% of PA chest radiographs
      28
    • Teaching Point / Left Paratracheal Stripe
      The left paratracheal stripe is seen lessfrequently than the right paratracheal stripe
      29
    • Teaching Point / Left Paratracheal Stripe
      30
    • Widening  of Left Paratracheal Stripe
      31
      WoodringJH, Daniel TL. Mediastinal analysis emphasizing plain radiographs and computed tomograms. Med Radiogr Photogr1986; 62:1–48.
    • PA Chest x Ray
      Widening of the left paratracheal stripe (arrows)
      with mass effect on the trachea
      32
    • Abnormal-appearing left paratracheal stripe
      A 47-year-old patient with metastatic thyroid carcinoma
      33
    • CT scan reveals a large thyroid mass (arrow) Supraclavicular lymphadenopathy *
      34
    • Chest radiograph with superimposed mediastinal stripes
      35
    • Normal chest x ray
      Left subclavian artery
      36
    • Left subclavian artery
      Aorta Angiogram
      37
    • Left subclavian artery / Angiogram
      Origin of subclavian
      38
    • Left subclavian artery / Angiogram
      Branches of subclavian artery
      39
    • Thoracic CT scan
      Left subclavian artery
      40
    • Thoracic CT scan
      Left subclavian artery
      41
    • Thoracic CT scan
      Left subclavian artery
      42
    • Posterior-superior junction line
      43
    • Chest radiograph with superimposed mediastinal stripes
      44
    • PA chest X ray shows the posterior junction line (arrow)
      Projecting through the tracheal air column
      45
    • PA chest X ray shows the posterior junction line (arrow)
      Note that the line extends above the level of the clavicles.
      46
    • 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
    • Anterior and Posterior Junction Lines
      Anterior junction line (retrosternal space)
      Posterior Junction lines (retrotracheal space)
      48
      
      
    • Anterior and Posterior Junction Lines
      CT through the upper thorax shows the anterior junction line in the retrosternal space
      The posterior junction line lies in the retrotracheal space
      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
    • 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
    • Can you guess the diagnosis ?
      Bronchogenic cyst
      Lymphoma
      Thymoma
      Teratoma
      Thyroid enlargement
    • Can you guess the diagnosis ?
      Bronchogenic cyst
      Lymphoma
      Thymoma
      Teratoma
      Thyroid enlargement
    • 54