This document discusses various mediastinal stripes and lines visible on chest radiographs. It describes the right and left paratracheal stripes, the posterior wall of the bronchus intermedius, the left subclavian artery border, and the posterior-superior junction line. Each structure is defined and its radiographic appearance is explained. Examples of normal and abnormal radiographic findings are provided to illustrate the structures. The document serves to teach readers how to identify and interpret common mediastinal landmarks on chest x-rays.

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. Topic
Outline
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
2

3. • Right paratracheal
stripe
3

4. Chest radiograph with
superimposed mediastinal
stripes
Yello
w
• Right
paratrache
al stripe
4

5. The right paratracheal stripe (open
arrows) is composed Of:
Right
lateral
tracheal
wall
Small amount
of
mediastinal
fat
Paratrache
al lymph
nodes
Visceral and
parietal pleural
layers of the
right upper
lobe
5

6. Right paratracheal
stripe
6

7. PAchest 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

8. CT scan helps confirm a large
right
paratracheal
mass
(arrow
)
8

9. Guess the effect of this mass please
!!
9

10. A. Anemia
B. Dysphonia.
C. Dysphasia.
D. Primary
hyperparathyroidism
10

11. WHY ?
Diffuse osteopenia from
primary
hyperparathyroidism.
11

12. Quiz : long solid
arrow is :
A
.
B
.
C
.
The right paratracheal stripe
The pulmonary artery
Anterior junction line
complex The pulmonary
veins

13. Quiz : long solid
arrow is :
A
.
B
.
C
.
The right paratracheal stripe
The pulmonary artery
Anterior junction line
complex The pulmonary
veins

14. 14

15. Posterior Wall Of The Bronchus
Intermedius
• Appears as a
stripe
15

16. Posterior Wall Of The Bronchus
Intermedius
• Appears on
lateral chest
radiographs
16

17. Posterior Wall Of The Bronchus
Intermedius
• It is important in
evaluating
mediastinal
disease
17

18. Posterior Wall Of The Bronchus
Intermedius
• The stripe
representing the
posterior wall of
the bronchus
intermedius
18

19. The posterior wall of the bronchus
intermedius is formed when
• Lung + Azygo-
esophageal
recess outlines
this posterior
wall
19

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. Posterior Wall Of The Bronchus
Intermedius
• This stripe is
present on
approximately
90%–95% of
lateral chest
radiographs
21

22. Normal thickness Posterior Wall Of The Bronchus
Intermedius
• Measures
between
0.5 and 3.0 mm
in thickness
22

23. Abnormal thickening of the posterior wall of the
bronchus
intermedius
• Cardiogenic pulmonary
23

24. Abnormal
thickening of the
posterior wall of
the bronchus
intermedius
Primary
lung
carcinom
a
Lymphadenopat
hy
Lympho
ma
Metastatic
disease
Tuberculo
sis
Sarcoido
sis
24
SchnurMJ, Winkler B, Austin JH. Thickening of the posterior wall of the
bronchus intermedius. Radiology1981; 139: 551–559.

25. 25
Left Paratracheal
Stripe

26. Left Paratracheal Stripe is formed by
contact between
Left
upper
lobe
Mediastin
al fat
Or left
Tracheal
wall
26

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. Teaching Point / Left Paratracheal
Stripe
• Visible on 21%–31% ofPAchest
radiographs
28

29. Teaching Point / Left Paratracheal
Stripe
29

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. 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

32. PA Chest x
Ray
Widening of
the left
paratrache
al stripe
(arrows)
with mass
effect on
the
trachea
32

33. Abnormal-
appearing left
paratracheal
stripe
A 47-year-old
patient with
metastatic
thyroid
carcinoma
33

34. CT scan reveals a large thyroid
mass
(arrow)
Supraclavicula
r
34

35. Chest radiograph with
superimposed mediastinal
stripes
Pin
k
• Left
subclavi
an
artery
border
35

36. Normal chest
x ray
Left
subclavi
an
artery
36

37. Left subclavian
artery
• Aorta
Angiogram
37

38. Left subclavian artery /
Angiogram
• Origin of
subclavian
38

39. Left subclavian artery /
Angiogram
• Branches of
subclavian
artery
39

40. Thoracic CT scan
Left subclavian artery
40

41. Thoracic CT scan
Left subclavian artery
41

42. Thoracic CT scan
Left subclavian artery
42

43. Posterior-superior junction
line
43

44. Chest radiograph with
superimposed
mediastinal stripes
Light
gree
n
• Posterior
-
superior
junction
line
44

45. PA chest X ray shows the posterior junction
line
(arrow)
Projecting through the
tracheal air column
45

46. PA chest X ray shows the posterior junction
line
(arrow)
Note that the line extends
above the level of the
clavicles.
46

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. Anterior and Posterior Junction
Lines
• Anterior junction
line
• Posterior Junction
(retrosternal
space)
(retrotracheal
48

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. 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. Can you guess the
diagnosis ?
A
.
B
.
C
Bronchogenic cyst
Lymphom
a
Thymoma
Teratoma

52. Can you guess the
diagnosis ?
A
.
B
.
C
Bronchogenic cyst
Lymphom
a
Thymoma
Teratoma

53. 54