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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