Lines & mediastinal stripes 02

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Anterior junction line complex
Aortic-Pulmonary Stripe
Right Paraspinal Line
Posterior Tracheal Stripe (Tracheoesophageal Stripe)
Azygoesophageal Recess

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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.
  • Anterior junction line on PA chest radiograph (arrows).
    Note that the line does not extend above the level of the c lavic les.
  • Abnormal-appearing anterior junction line in a patient who had undergone a right middle lobectomy. (a) Frontal chest radiograph shows the anterior junction line (arrows) displaced to the right. Note also the volume loss in the right lung as demonstrated by elevation of the right hemidiaphragm.
  • Abnormal-appearing anterior junction line in a patient who had undergone a right middle lobectomy. (a) Frontal chest radiograph shows the anterior junction line (arrows) displaced to the right. Note also the volume loss in the right lung as demonstrated by elevation of the right hemidiaphragm.
  • Abnormal-appearing anterior junction line in a patient who had undergone a right middle lobectomy. (a) Frontal chest radiograph shows the anterior junction line (arrows) displaced to the right. Note also the volume loss in the right lung as demonstrated by elevation of the right hemidiaphragm.
  • Abnormal-appearing anterior junction line in a patient who had undergone a right middle lobectomy. (a) Frontal chest radiograph shows the anterior junction line (arrows) displaced to the right. Note also the volume loss in the right lung as demonstrated by elevation of the right hemidiaphragm.
  • Anterior and Posterior Junction Lines. A. A posteroanterior chest film shows both anterior (solid arrows) and posterior (open arrows) junction lines. B. CT through the upper thorax in another patient shows the anterior junction line in the retrosternal space, while the posterior junction line lies in the retrotracheal space.
  • First described by Keats (7), the aortic-pulmo-nary stripe actually represents a mediastinal reflection or interface formed by the pleura of the anterior left lung coming in contact with and tangentially reflecting over the mediastinal fat anterolateral to the left pulmonary artery and aortic arch. The stripe is straight or mildly convex, crossing laterally over the aortic arch and the main pulmonary artery
  • First described by Keats (7), the aortic-pulmo-nary stripe actually represents a mediastinal reflection or interface formed by the pleura of the anterior left lung coming in contact with and tangentially reflecting over the mediastinal fat anterolateral to the left pulmonary artery and aortic arch. The stripe is straight or mildly convex, crossing laterally over the aortic arch and the main pulmonary artery
  • CT scan shows a normal aortic-pulmonary
    stripe (arrows) formed by the anterior left lung contacting
    and tangentially reflecting over the mediastinal fat anterolateral
    to the left pulmonary artery and aortic arch.
  • Abnormal-appearing aortic-pulmonary stripe in a 42-year-old patient with lymphoma. (a) Frontal chest
    radiograph demonstrates abnormal contour of the aortic-pulmonary stripe (arrows). (b) CT scan shows anterior mediastinal
    lymphadenopathy (arrows) within the prevascular space.
  • Abnormal-appearing aortic-pulmonary stripe in a 42-year-old patient with lymphoma. (a) Frontal chest
    radiograph demonstrates abnormal contour of the aortic-pulmonary stripe (arrows). (b) CT scan shows anterior mediastinal
    lymphadenopathy (arrows) within the prevascular space.
  • Abnormal-appearing aortic-pulmonary stripe in a 42-year-old patient with lymphoma. (a) Frontal chest
    radiograph demonstrates abnormal contour of the aortic-pulmonary stripe (arrows). (b) CT scan shows anterior mediastinal
    lymphadenopathy (arrows) within the prevascular space.
  • Keats’ original study described elevation of the
    aortic-pulmonary stripe in two patients with
    pneumomediastinum (7). Anterior mediastinal
    disease such as thyroid or thymic masses or prevascular
    lymphadenopathy (Fig 13) may alter
    the normal appearance of the stripe, causing increased
    convexity laterally (8).
  • 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 paraspinal line appears straight and typically extends from the 8th through the 12th thoracic vertebral levels
  • CT scan shows normal right and left paraspinal lines (arrows) formed by the lungs and pleura contacting the posterior mediastinal soft tissues.
  • Abnormal-appearing right paraspinal line in a 27-year-old patient who had sustained traumatic injury.
  • CT scan reveals a large mediastinal hematoma (arrow) from multiple right-sided transverse process fractures of the thoracic spine and an associated right hemothorax.
  • CT scan reveals a large mediastinal hematoma (arrow) from multiple right-sided transverse process fractures of the thoracic spine and an associated right hemothorax.
  • The left paraspinal line is formed by tangential contact of the left lung and pleura with the posterior mediastinal fat, left paraspinal muscles, and adjacent soft tissues. The left paraspinal line extends vertically from the aortic arch to the diaphragm and typically lies medial to the lateral wall of the descending thoracic aorta (Figs 18, 20) (1). In some instances, however, it may lie lateral to the aorta along the lower intrathoracic course of the aorta.
  • The left paraspinal line is formed by tangential contact of the left lung and pleura with the posterior mediastinal fat, left paraspinal muscles, and adjacent soft tissues. The left paraspinal line extends vertically from the aortic arch to the diaphragm and typically lies medial to the lateral wall of the descending thoracic aorta (Figs 18, 20) (1). In some instances, however, it may lie lateral to the aorta along the lower intrathoracic course of the aorta.
  • The left paraspinal line is formed by tangential contact of the left lung and pleura with the posterior mediastinal fat, left paraspinal muscles, and adjacent soft tissues. The left paraspinal line extends vertically from the aortic arch to the diaphragm and typically lies medial to the lateral wall of the descending thoracic aorta (Figs 18, 20) (1). In some instances, however, it may lie lateral to the aorta along the lower intrathoracic course of the aorta.
  • The left paraspinal line is formed by tangential contact of the left lung and pleura with the posterior mediastinal fat, left paraspinal muscles, and adjacent soft tissues. The left paraspinal line extends vertically from the aortic arch to the diaphragm and typically lies medial to the lateral wall of the descending thoracic aorta (Figs 18, 20) (1). In some instances, however, it may lie lateral to the aorta along the lower intrathoracic course of the aorta.
  •  Reported on 41% of posteroanterior radiographs, the left paraspinal line is seen more frequently than the right paraspinal line due to the presence of the descending thoracic aorta on the left, which promotes the tangential contact of the left lung necessary to produce the lung-mediastinum interface
  •  Reported on 41% of posteroanterior radiographs, the left paraspinal line is seen more frequently than the right paraspinal line due to the presence of the descending thoracic aorta on the left, which promotes the tangential contact of the left lung necessary to produce the lung-mediastinum interface
  • As with the right paraspinal line, osteophytes or prominent mediastinal fat can cause an abnormal contour of the left paraspinal line; however, tortuosity of the descending thoracic aorta may also displace it. Abnormal contour or displacement may also suggest additional posterior mediastinal abnormalities such as a mediastinal hematoma, a mass, extramedullary hematopoiesis, or esophageal varices
  • As with the right paraspinal line, osteophytes or prominent mediastinal fat can cause an abnormal contour of the left paraspinal line; however, tortuosity of the descending thoracic aorta may also displace it. Abnormal contour or displacement may also suggest additional posterior mediastinal abnormalities such as a mediastinal hematoma, a mass, extramedullary hematopoiesis, or esophageal varices
  • As with the right paraspinal line, osteophytes or prominent mediastinal fat can cause an abnormal contour of the left paraspinal line; however, tortuosity of the descending thoracic aorta may also displace it. Abnormal contour or displacement may also suggest additional posterior mediastinal abnormalities such as a mediastinal hematoma, a mass, extramedullary hematopoiesis, or esophageal varices
  • The posterior tracheal stripe is a vertical stripe seen on lateral chest radiographs that is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues (Figs 22, 23) (10,11). It typically measures up to 2.5 mm in thickness. When the posterior trachea comes in contact with the anterior wall of the esophagus, however, the esophageal wall, the posterior tracheal wall, and intervening soft tissues combine to form a thicker tracheoesophageal stripe, which may measure up to 5.5 mm
  • The posterior tracheal stripe is a vertical stripe seen on lateral chest radiographs that is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues (Figs 22, 23) (10,11). It typically measures up to 2.5 mm in thickness. When the posterior trachea comes in contact with the anterior wall of the esophagus, however, the esophageal wall, the posterior tracheal wall, and intervening soft tissues combine to form a thicker tracheoesophageal stripe, which may measure up to 5.5 mm
  • The posterior tracheal stripe is a vertical stripe seen on lateral chest radiographs that is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues It typically measures up to 2.5 mm in thickness. When the posterior trachea comes in contact with the anterior wall of the esophagus, however, the esophageal wall, the posterior tracheal wall, and intervening soft tissues combine to form a thicker tracheoesophageal stripe, which may measure up to 5.5 mm

    FranquetT, Erasmus JJ, Gimenez A, Rossi S, Pratts R. The retrotracheal space: normal anatomic and pathologic appearances.RadioGraphics2002; 22(spec no): S231–S246.
  • The posterior tracheal stripe is a vertical stripe seen on lateral chest radiographs that is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues It typically measures up to 2.5 mm in thickness. When the posterior trachea comes in contact with the anterior wall of the esophagus, however, the esophageal wall, the posterior tracheal wall, and intervening soft tissues combine to form a thicker tracheoesophageal stripe, which may measure up to 5.5 mm

    FranquetT, Erasmus JJ, Gimenez A, Rossi S, Pratts R. The retrotracheal space: normal anatomic and pathologic appearances.RadioGraphics2002; 22(spec no): S231–S246.
  • CT scan reveals that the posterior tracheal stripe (arrow) is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • A: PA view showingt trachea (1), right mainstem
    bronchus (2), left mainstem bronchus (3), aort ic “knob” or arch (4), azygos
    vein empt ying into superior vena cava (5), right interlobar pulmonary artery
    (6), left pulmonary artery (7), right upper lobe pulmonary artery (t runc us
    anterior) (8), right inferior pulmonary vein (9), right at rium (10), left vent ric le
    (11), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • Lateral view showing pulmonary
    out flow t rac t (1), ascending aorta (2), aort ic arch (3), brac hioc ephalic
    vessels (4), t rachea (5), right upper lobe bronchus (6), left upper lobe
    bronchus (7), right pulmonary artery (8), left pulmonary artery (9),
    c onfluenc e of pulmonary veins (10), and other st ruc tures as labeled.
  • The posterior tracheal stripe forms the anterior border of the retrotracheal space (Raider or retro-tracheal triangle), with the remaining borders being the spine posteriorly, the aortic arch inferiorly, and the thoracic inlet superiorly
  • The posterior tracheal stripe forms the anterior border of the retrotracheal space (Raider or retro-tracheal triangle), with the remaining borders being the spine posteriorly, the aortic arch inferiorly, and the thoracic inlet superiorly
  • Franquet et al observed that the most common abnormalities within the retrotracheal space are congenital developmental anomalies of the aortic arch.
  • Acquired vascular lesions, esophageal lesions, lymphatic malformations, mediastinitis, and post-traumatic hematomas may also cause abnormal thickening of the posterior tracheal stripe
  • CT scan demonstrates a dilated esophagus (arrow) filled with food and contrast material.
  • Abnormal posterior tracheal stripe in a 49-year-old patient with achalasia
  • Abnormal posterior tracheal stripe in a 49-year-old patient with achalasia
  • Although not considered a mediastinal line or stripe, the azygoesophageal recess remains an important mediastinal interface caused by differences in density between the mediastinum and the posteromedial portion of the right lower lobe. The azygoesophageal recess represents a space lying lateral or posterior to the esophagus and anterior to the spine, extending from the level of the anterior turn of the azygos vein to the level of the aortic hiatus inferiorly.The right infraazygos pleuroesophageal stripe may also outline the recess and is formed when an air-filled esophagus and intervening pleura come in contact with the right lower lobe .
    Superiorly, the recess is continuous with the subcarinal space and may demonstrate mild leftward convexity in that location .The middle third of the recess may be the most variable in appearance but typically is straight edged or shows mild leftward convexity. The lower third typically appears as a straight edge .Right superior convexity may be seen in children and younger adults but is abnormal in the elderly. Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias ,bronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial enlargement .
  • Although not considered a mediastinal line or stripe, the azygoesophageal recess تجويف remains an important mediastinal interface caused by differences in density between the mediastinum and the posteromedial portion of the right lower lobe. The azygoesophageal recess represents a space lying lateral or posterior to the esophagus and anterior to the spine, extending from the level of the anterior turn of the azygos vein to the level of the aortic hiatus inferiorly.The right infraazygos pleuroesophageal stripe may also outline the recess and is formed when an air-filled esophagus and intervening pleura come in contact with the right lower lobe .
    Superiorly, the recess is continuous with the subcarinal space and may demonstrate mild leftward convexity in that location .The middle third of the recess may be the most variable in appearance but typically is straight edged or shows mild leftward convexity. The lower third typically appears as a straight edge .Right superior convexity may be seen in children and younger adults but is abnormal in the elderly. Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias ,bronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial enlargement .
  • Although not considered a mediastinal line or stripe, the azygoesophageal recess تجويف remains an important mediastinal interface caused by differences in density between the mediastinum and the posteromedial portion of the right lower lobe. The azygoesophageal recess represents a space lying lateral or posterior to the esophagus and anterior to the spine, extending from the level of the anterior turn of the azygos vein to the level of the aortic hiatus inferiorly.The right infraazygos pleuroesophageal stripe may also outline the recess and is formed when an air-filled esophagus and intervening pleura come in contact with the right lower lobe .
    Superiorly, the recess is continuous with the subcarinal space and may demonstrate mild leftward convexity in that location .The middle third of the recess may be the most variable in appearance but typically is straight edged or shows mild leftward convexity. The lower third typically appears as a straight edge .Right superior convexity may be seen in children and younger adults but is abnormal in the elderly. Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias ,bronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial enlargement .
  • Although not considered a mediastinal line or stripe, the azygoesophageal recess تجويف remains an important mediastinal interface caused by differences in density between the mediastinum and the posteromedial portion of the right lower lobe. The azygoesophageal recess represents a space lying lateral or posterior to the esophagus and anterior to the spine, extending from the level of the anterior turn of the azygos vein to the level of the aortic hiatus inferiorly.The right infraazygos pleuroesophageal stripe may also outline the recess and is formed when an air-filled esophagus and intervening pleura come in contact with the right lower lobe .
    Superiorly, the recess is continuous with the subcarinal space and may demonstrate mild leftward convexity in that location .The middle third of the recess may be the most variable in appearance but typically is straight edged or shows mild leftward convexity. The lower third typically appears as a straight edge .Right superior convexity may be seen in children and younger adults but is abnormal in the elderly. Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias ,bronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial enlargement .
  • Although not considered a mediastinal line or stripe, the azygoesophageal recess تجويف remains an important mediastinal interface caused by differences in density between the mediastinum and the posteromedial portion of the right lower lobe. The azygoesophageal recess represents a space lying lateral or posterior to the esophagus and anterior to the spine, extending from the level of the anterior turn of the azygos vein to the level of the aortic hiatus inferiorly.The right infraazygos pleuroesophageal stripe may also outline the recess and is formed when an air-filled esophagus and intervening pleura come in contact with the right lower lobe .
    Superiorly, the recess is continuous with the subcarinal space and may demonstrate mild leftward convexity in that location .The middle third of the recess may be the most variable in appearance but typically is straight edged or shows mild leftward convexity. The lower third typically appears as a straight edge .Right superior convexity may be seen in children and younger adults but is abnormal in the elderly. Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias ,bronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial enlargement .
  •  Abnormal contour and convexity may be due to lymphadenopathy, hiatal hernias فتق حجابيbronchopulmonary-foregut malformations, esophageal neoplasms, pleural abnormalities, and cardiomegaly with left atrial enlargement
  • CT scan shows a large hiatal hernia (arrow) that causes a rightward bulge of the distal azygoesophageal recess.
  • 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.
  • Lines & mediastinal stripes 02

    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 - 02
    2. 2. Topic Outline 2 1. Anterior junction line complex 2. Aortic-Pulmonary Stripe 3. Right Paraspinal Line 4. Posterior Tracheal Stripe (Tracheoesophageal Stripe) 5. Azygoesophageal Recess
    3. 3. Anterior junction line complex 3
    4. 4. Chest radiograph with superimposed mediastinal stripes Purple • Anterior junction line complex 4
    5. 5. Anterior junction line on PA chest radiograph (arrows) Note that the line does not extend above the level of the clavicles 5
    6. 6. Anterior junction line complex 6
    7. 7. Quiz • What are the signs that you see in chest x-ray? 7
    8. 8. What are the signs that you see in chest x-ray? • Loss in the volume of the right lung • As demonstrated by elevation of the right hemidiaphragm. 8
    9. 9. What are the signs that you see in chest x-ray? • Frontal chest radiograph shows the anterior junction line (arrows) displaced to the right. 9
    10. 10. CT scan helps confirm rightward displacement of the anterior junction line (arrow) with volume loss in the right lung. 10
    11. 11. Guess the Diagnosis ? • Abnormal-appearing anterior junction line in a patient who had undergone a right middle lobectomy11
    12. 12. Anterior and posterior junction lines mediastinum 12
    13. 13. 13
    14. 14. Aortic-Pulmonary Stripe (A mediastinal interface ) Formed The pleura of the anterior left lung The mediastinal fat of anterolateral to The left pulmonary artery Aortic arch 14
    15. 15. Aortic-Pulmonary Stripe • The stripe is straight or mildly convex, crossing laterally over the aortic arch and the main pulmonary artery 15
    16. 16. Aortic-Pulmonary Stripe • CT scan shows a normal aortic- pulmonary stripe (arrows) 16
    17. 17. Aortic-Pulmonary Stripe / Chest x ray • Abnormal contour of the aortic- pulmonary stripe (arrows) 17
    18. 18. Aortic-Pulmonary Stripe 18 • CT scan shows anterior mediastinal lymphadenopathy (arrows) within the prevascular space
    19. 19. Guess the Diagnosis ? 19 Abnormal-appearing aortic-pulmonary stripe in a 42-year-old patient with lymphoma
    20. 20. Elevation of the aortic-pulmonary stripe Pneumomediastinum Anterior mediastinal disease Thyroid masses Thymic masses Prevascular lymphadenopathy 20 KeatsTE. The aortic-pulmonary mediastinal stripe. Am J Roentgenol Radium Ther Nucl Med1972; 116: 107–109
    21. 21. 21
    22. 22. Chest radiograph with superimposed mediastinal stripes Light blue Right paraspinal stripe 22
    23. 23. Right and left paraspinal stripes (A mediastinal interface ) • It represents an interface between the right lung and the posterior mediastinal fat and soft tissues. 23
    24. 24. Right paraspinal stripes • The right paraspinal line appears straight and typically extends from T8 – T1224
    25. 25. Right paraspinal stripes • Its presence on 23% of posteroanterior radiographs 25
    26. 26. The right paraspinal line may be displaced laterally Osteophytes A mediastinal fat A mediastinal hematoma 26
    27. 27. Abnormal-appearing right paraspinal line in a Frontal chest radiograph • An abnormal bulge in the right paraspinal line inferiorly (arrows) 27
    28. 28. Abnormal-appearing right paraspinal line in CT scan • An abnormal bulge in the right paraspinal line inferiorly (arrows) 28
    29. 29. Guess the Diagnosis ? Abnormal-appearing right paraspinal line in a 27-year- old patient who had sustained traumatic injury 29
    30. 30. Left Paraspinal Line 30
    31. 31. Chest radiograph with superimposed mediastinal stripes Light blue Left paraspinal stripe 31
    32. 32. Left paraspinal stripe Contact of The left lung Pleura Posterior mediastinal fat Left paraspinal muscles Adjacent soft tissues 32
    33. 33. Left paraspinal stripe • The left paraspinal line extends vertically from the aortic arch to the diaphragm 33
    34. 34. Left paraspinal stripe • The normal left paraspinal line typically lies medial to the lateral wall of the descending thoracic aorta. 34
    35. 35. Left paraspinal stripe • Reported on 41% of PA radiographs 35
    36. 36. Left paraspinal stripe 36 • The left paraspinal line is seen more frequently than the right paraspinal line due to the presence of the descending thoracic aorta on the left
    37. 37. An abnormal contour of the left paraspinal line Tortuosity Of The Descending Thoracic Aorta Osteophytes A Mediastinal Fat 37
    38. 38. An abnormal contour of the left paraspinal line A Mediastinal Hematoma Extramedullary Hematopoiesis Esophageal Varices 38
    39. 39. An abnormal contour of the left paraspinal line 39 • CT scan shows extensive esophageal varices (arrow), which are responsible for the abnormal contour of the left paraspinal line.
    40. 40. 40
    41. 41. The posterior tracheal stripe 41 FranquetT, Erasmus JJ, Gimenez A, Rossi S, Pratts R. The retrotracheal space: normal anatomic and pathologic appearances.RadioGraphics2002; 22(spec no): S231–S246. • Is a vertical stripe seen on lateral chest radiographs
    42. 42. The posterior tracheal stripe • That is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues 42 FranquetT, Erasmus JJ, Gimenez A, Rossi S, Pratts R. The retrotracheal space: normal anatomic and pathologic appearances.RadioGraphics2002; 22(spec no): S231–S246.
    43. 43. The posterior tracheal stripe • It typically measures up to 2.5 mm in thickness 43 ProtoAV, Speckman JM. The left lateral radiograph of the chest. I.Med Radiogr Photogr1979; 55: 29–74.
    44. 44. Refresh your Knowledge 1. ……………… 46
    45. 45. Refresh your Knowledge 1. Trachea 47
    46. 46. Refresh your Knowledge 2. …………. 48
    47. 47. Refresh your Knowledge 2. Right mainstem bronchus 49
    48. 48. Refresh your Knowledge 3. ……………… 50
    49. 49. Refresh your Knowledge 3. Left mainstem bronchus 51
    50. 50. Refresh your Knowledge 4……………… 52
    51. 51. Refresh your Knowledge 4. Aortic “knob” or arch 53
    52. 52. Refresh your Knowledge 5. ……………….. 54
    53. 53. Refresh your Knowledge 5. azygos vein emptying into superior vena cava 55
    54. 54. Refresh your Knowledge 6. ………………….. 56
    55. 55. Refresh your Knowledge 6. Right interlobar pulmonary artery 57
    56. 56. Refresh your Knowledge 7. ………………… 58
    57. 57. Refresh your Knowledge 7. Left pulmonary artery 59
    58. 58. Refresh your Knowledge 8. ………………. 60
    59. 59. Refresh your Knowledge 8. Right upper lobe pulmonary artery (truncus anterior) 61
    60. 60. Refresh your Knowledge 9. …………….. 62
    61. 61. Refresh your Knowledge 9. Right inferior pulmonary vein 63
    62. 62. Refresh your Knowledge 10……………. 64
    63. 63. Refresh your Knowledge 10. right atrium 65
    64. 64. Refresh your Knowledge 11. …………… 66
    65. 65. Refresh your Knowledge 11. left ventricle 67
    66. 66. Refresh your Knowledge 01. ………………… 68
    67. 67. Refresh your Knowledge 01.Retrosternal space 69
    68. 68. Refresh your Knowledge 02. …………….. 70
    69. 69. Refresh your Knowledge 02. Ascending aorta 71
    70. 70. Refresh your Knowledge 03. ………….. 72
    71. 71. Refresh your Knowledge 03. Aortic arch 73
    72. 72. Refresh your Knowledge 04. ……………….. 74
    73. 73. Refresh your Knowledge 04. brachiocephalic vessels 75
    74. 74. Refresh your Knowledge 05. …………. 76
    75. 75. Refresh your Knowledge 05. Trachea 77
    76. 76. Refresh your Knowledge 06. ………………. 78
    77. 77. Refresh your Knowledge 06. Right upper lobe bronchus 79
    78. 78. Refresh your Knowledge 07………………… 80
    79. 79. Refresh your Knowledge 07. Left upper lobe bronchus 81
    80. 80. Refresh your Knowledge 08. ……………… 82
    81. 81. Refresh your Knowledge 08. right pulmonary artery 83
    82. 82. Refresh your Knowledge 09. ……………………. 84
    83. 83. Refresh your Knowledge 09. Left pulmonary artery 85
    84. 84. Refresh your Knowledge 10. ………………… 86
    85. 85. Refresh your Knowledge 10. confluence of pulmonary veins 87
    86. 86. The posterior tracheal stripe • Retro-tracheal triangle 88
    87. 87. The posterior tracheal stripe 89 thoracic inlet aortic arch
    88. 88. Why should we distinguish the posterior tracheal stripe & Retro-tracheal triangle ? • Franquet et al observed that the most common abnormalities within the retrotracheal space are congenital developmental anomalies of the aortic arch 90 FranquetT, Erasmus JJ, Gimenez A, Rossi S, Pratts R. The retrotracheal space: normal anatomic and pathologic appearances.RadioGraphics2002; 22(spec no): S231–S246.
    89. 89. Abnormal thickening of the posterior tracheal stripe Acquired vascular lesions Esophageal lesions Lymphatic malformations Mediastinitis Post-traumatic hematomas 91
    90. 90. Lateral chest radiograph Shows widening of the posterior tracheal stripe (arrows) 92
    91. 91. CT scan Demonstrates a dilated esophagus (arrow) filled with food and contrast material 93
    92. 92. Guess the Diagnosis ? Abnormal posterior tracheal stripe in a 49-year-old patient with …………………… 94
    93. 93. Guess the Diagnosis ? Abnormal posterior tracheal stripe in a 49-year-old patient with Achalasia 95
    94. 94. 96
    95. 95. Chest radiograph with superimposed mediastinal stripes Red Azygoesophageal stripe 97
    96. 96. Azygoesophageal recess Not considered a mediastinal line or stripe 98
    97. 97. Azygoesophageal recess An important mediastinal interface caused by differences in density between the mediastinum and the posteromedial portion of the right lower lobe 99
    98. 98. CT scan The azygoesophageal recess represents a space lying lateral or posterior to the esophagus and anterior to the spine 100
    99. 99. Mild leftward convexity superiorly and a straight edge inferiorly 101
    100. 100. Abnormal contour of Azygoesophageal recess Lymphadenopathy Hiatal hernias Bronchopulmonary- foregut malformations Esophageal neoplasms Pleural abnormalities Cardiomegaly with left atrial enlargement 102
    101. 101. Abnormal contour of Azygoesophageal recess • The distal third of the azygoesophageal recess demonstrates an abnormal contour and right lateral convexity (arrows) 103
    102. 102. Guess the diagnosis • A large hiatal hernia 104
    103. 103. A large hiatal hernia • CT scan shows a large hiatal hernia (arrow) that causes a rightward bulge of the distal azygoesophageal recess. 105
    104. 104. Chest radiograph with superimposed mediastinal stripes Dark green Para-aortic line 106
    105. 105. Chest radiograph with superimposed mediastinal stripes Brown pleuroesophageal stripe 107
    106. 106. 108

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