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
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
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
4. Chest radiograph with superimposed
mediastinal stripes
Yellow
• Right
paratracheal
stripe
4
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
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. CT scan helps confirm a large right
paratracheal mass (arrow)
8
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. 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
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 edema23
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.
26. Left Paratracheal Stripe is formed by contact
between
Left upper
lobe
Mediastinal
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% of PA chest radiographs
28
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
and computed tomograms. Med Radiogr Photogr1986; 62:1–48.
32. PA Chest x Ray
Widening of
the left
paratracheal
stripe (arrows)
with mass
effect on the
trachea
32
44. Chest radiograph with superimposed
mediastinal stripes
Light
green
• 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 (retrosternal space)
• Posterior Junction lines (retrotracheal space)
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. Bronchogenic cyst
B. Lymphoma
C. Thymoma
D. Teratoma
E. Thyroid enlargement
52. Can you guess the diagnosis ?
A. Bronchogenic cyst
B. Lymphoma
C. Thymoma
D. Teratoma
E. Thyroid enlargement
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).