lines & mediastinal stripes 01
DESCRIPTION
Right Paratracheal StripePosterior wall of the bronchus intermediusLeft Paratracheal StripeLeft subclavian artery borderPosterior-superior junction lineTRANSCRIPT
![Page 1: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/1.jpg)
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail: [email protected]
Lines & mediastinal Stripes - 01
![Page 2: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/2.jpg)
2
Topic Outline
1. Right Paratracheal Stripe2. Posterior wall of the bronchus intermedius3. Left Paratracheal Stripe4. Left subclavian artery border5. Posterior-superior junction line
![Page 3: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/3.jpg)
3
• Right paratracheal stripe
![Page 4: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/4.jpg)
Chest radiograph with superimposed mediastinal stripes
Yellow• Right
paratracheal stripe
4
![Page 5: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/5.jpg)
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 lobe5
![Page 6: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/6.jpg)
6
Right paratracheal stripe
![Page 7: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/7.jpg)
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
![Page 8: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/8.jpg)
CT scan helps confirm a large right paratracheal mass (arrow)
8
![Page 9: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/9.jpg)
Guess the effect of this mass please !!
9
![Page 10: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/10.jpg)
A. AnemiaB. Dysphonia.C. Dysphasia.D. Primary hyperparathyroidism
10
![Page 11: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/11.jpg)
WHY ?Diffuse osteopenia from primary hyperparathyroidism.
11
![Page 12: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/12.jpg)
Quiz : long solid arrow is :
A. The right paratracheal stripe B. The pulmonary arteryC. Anterior junction line complexD. The pulmonary veinsE. The posterior wall of the bronchus intermedius
![Page 13: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/13.jpg)
Quiz : long solid arrow is :
A. The right paratracheal stripe B. The pulmonary arteryC. Anterior junction line complexD. The pulmonary veinsE. The posterior wall of the bronchus intermedius
![Page 14: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/14.jpg)
14
Posterior wall of the Bronchus Intermedius
![Page 15: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/15.jpg)
15
Posterior Wall Of The Bronchus Intermedius
• Appears as a stripe
![Page 16: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/16.jpg)
16
Posterior Wall Of The Bronchus Intermedius
• Appears on lateral chest radiographs
![Page 17: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/17.jpg)
17
Posterior Wall Of The Bronchus Intermedius
• It is important in evaluating mediastinal disease
![Page 18: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/18.jpg)
18
Posterior Wall Of The Bronchus Intermedius
• The stripe representing the posterior wall of the bronchus intermedius
![Page 19: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/19.jpg)
19
The posterior wall of the bronchus intermedius is formed when
• Lung + Azygo-esophageal recess outlines this posterior wall
![Page 20: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/20.jpg)
20
Posterior Wall Of The Bronchus Intermedius
• Appears asA thinVertical or slightly
oblique stripe that typically projects
through the radiolucent area created by the left upper lobe bronchus
![Page 21: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/21.jpg)
21
Posterior Wall Of The Bronchus Intermedius
• This stripe is present on approximately 90%–95% of lateral chest radiographs
![Page 22: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/22.jpg)
22
Normal thickness Posterior Wall Of The Bronchus Intermedius
• Measures between 0.5 and 3.0 mm in thickness
![Page 23: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/23.jpg)
23
Abnormal thickening of the posterior wall of the bronchus intermedius
• Cardiogenic pulmonary edema
![Page 24: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/24.jpg)
24
Abnormal thickening of the posterior wall of the bronchus intermedius
Primary lung carcinoma Lymphadenopathy
Lymphoma
Metastatic disea
se
Tuberculo
sis
Sarcoidosis
SchnurMJ, Winkler B, Austin JH. Thickening of the posterior wall of the bronchus intermedius. Radiology1981; 139: 551–559.
![Page 25: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/25.jpg)
25
Left Paratracheal Stripe
![Page 26: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/26.jpg)
26
Left Paratracheal Stripe is formed by contact between
Left upper lobe
Mediastinal fat
Or left Tracheal wall
![Page 27: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/27.jpg)
27
Left Paratracheal Stripe
The stripe is extending superiorly from the
aortic arch
To join with the reflection from the left subclavian
artery superiorly
![Page 28: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/28.jpg)
28
Teaching Point / Left Paratracheal Stripe
• Visible on 21%–31% of PA chest radiographs
![Page 29: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/29.jpg)
29
Teaching Point / Left Paratracheal Stripe
• The left paratracheal stripe is seen less frequently than the right paratracheal stripe
![Page 30: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/30.jpg)
30
Teaching Point / Left Paratracheal Stripe
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
![Page 31: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/31.jpg)
31
Widening of Left Paratracheal Stripe
Neoplasm
Mediastinal hematoma
WoodringJH, Daniel TL. Mediastinal analysis emphasizing plain radiographs and computed tomograms. Med Radiogr Photogr1986; 62:1–48.
![Page 32: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/32.jpg)
32
PA Chest x Ray
Widening of the left paratracheal stripe (arrows)
with mass effect on the trachea
![Page 33: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/33.jpg)
33
Abnormal-appearing left paratracheal
stripe
A 47-year-old patient with metastatic thyroid carcinoma
![Page 34: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/34.jpg)
34
CT scan reveals a large thyroid mass (arrow)
Supraclavicular lymphadenopathy *
![Page 35: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/35.jpg)
Chest radiograph with superimposed mediastinal stripes
Pink
• Left subcla
vian artery borde
r35
![Page 36: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/36.jpg)
36
Normal chest x ray
Left subclavian artery
![Page 37: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/37.jpg)
37
Left subclavian artery
• Aorta Angiogram
![Page 38: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/38.jpg)
38
Left subclavian artery / Angiogram
• Origin of subclavian
![Page 39: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/39.jpg)
39
Left subclavian artery / Angiogram
• Branches of subclavian artery
![Page 40: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/40.jpg)
40
Thoracic CT scan
Left subclavian artery
![Page 41: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/41.jpg)
41
Thoracic CT scan
Left subclavian artery
![Page 42: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/42.jpg)
42
Thoracic CT scan
Left subclavian artery
![Page 43: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/43.jpg)
43
Posterior-superior junction line
![Page 44: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/44.jpg)
Chest radiograph with superimposed mediastinal stripes
Light green
•Posterior-
superior
junction line
44
![Page 45: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/45.jpg)
45
PA chest X ray shows the posterior junction line (arrow)
Projecting through the tracheal air column
![Page 46: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/46.jpg)
PA chest X ray shows the posterior junction line (arrow)
Note that the line extends above the level of the clavicles.
46
![Page 47: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/47.jpg)
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
![Page 48: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/48.jpg)
Anterior and Posterior Junction Lines
• Anterior junction line (retrosternal space)• Posterior Junction lines (retrotracheal space)
48
![Page 49: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/49.jpg)
PA chest X ray shows a mass (arrow)
obliterating the posterior junction lineNote that the mass extends above the level of the clavicle
50
![Page 50: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/50.jpg)
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
![Page 51: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/51.jpg)
Can you guess the diagnosis ?
A. Bronchogenic cystB. LymphomaC. ThymomaD. TeratomaE. Thyroid enlargement
![Page 52: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/52.jpg)
Can you guess the diagnosis ?
A. Bronchogenic cystB. LymphomaC. ThymomaD. TeratomaE. Thyroid enlargement
![Page 53: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/53.jpg)
54
![Page 54: Lines & mediastinal stripes 01](https://reader035.vdocuments.us/reader035/viewer/2022062303/55496781b4c905dd558b4a64/html5/thumbnails/54.jpg)