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Dr Mazen Qusaibaty
MD, DIS
Head Pulmonary and Internist Department
Ibnalnafisse Hospital
Ministry of Syrian health
Email: ...
Topic Outline
2
1. Anterior junction line complex
2. Aortic-Pulmonary Stripe
3. Right Paraspinal Line
4. Posterior Trachea...
Anterior junction line complex
3
Chest radiograph with superimposed
mediastinal stripes
Purple
• Anterior
junction
line
complex
4
Anterior junction line on PA chest
radiograph (arrows)
Note that the line does not extend
above the level of the clavicles...
Anterior junction line complex
6
Quiz
• What are the signs
that you see in chest
x-ray?
7
What are the signs that you see in chest x-ray?
• Loss in the volume
of the right lung
• As demonstrated by
elevation of t...
What are the signs that you see in chest x-ray?
• Frontal chest
radiograph shows the
anterior junction line
(arrows) displ...
CT scan helps confirm rightward
displacement of the anterior junction
line (arrow) with volume loss in the
right lung.
10
Guess the Diagnosis ?
• Abnormal-appearing anterior junction line in a
patient who had undergone a right middle
lobectomy11
Anterior and posterior junction lines
mediastinum
12
13
Aortic-Pulmonary Stripe
(A mediastinal interface )
Formed
The pleura
of the
anterior
left lung
The mediastinal fat of
ante...
Aortic-Pulmonary Stripe
• The stripe is straight or mildly convex, crossing
laterally over the aortic arch and the main
pu...
Aortic-Pulmonary Stripe
• CT scan shows a
normal aortic-
pulmonary stripe
(arrows)
16
Aortic-Pulmonary Stripe / Chest x ray
• Abnormal contour
of the aortic-
pulmonary stripe
(arrows)
17
Aortic-Pulmonary Stripe
18
• CT scan shows
anterior mediastinal
lymphadenopathy
(arrows) within the
prevascular space
Guess the Diagnosis ?
19
Abnormal-appearing aortic-pulmonary stripe in a
42-year-old patient with lymphoma
Elevation of the aortic-pulmonary stripe
Pneumomediastinum
Anterior mediastinal
disease
Thyroid masses Thymic masses
Preva...
21
Chest radiograph with superimposed
mediastinal stripes
Light blue
Right paraspinal
stripe
22
Right and left paraspinal stripes
(A mediastinal interface )
• It represents an
interface between
the right lung and
the p...
Right paraspinal stripes
• The right paraspinal line appears straight and
typically extends from T8 – T1224
Right paraspinal stripes
• Its presence on 23%
of posteroanterior
radiographs
25
The right paraspinal line may be displaced
laterally
Osteophytes
A mediastinal
fat
A mediastinal
hematoma
26
Abnormal-appearing right paraspinal line in a Frontal
chest radiograph
• An abnormal bulge
in the right
paraspinal line
in...
Abnormal-appearing right paraspinal line in CT scan
• An abnormal bulge
in the right
paraspinal line
inferiorly (arrows)
28
Guess the Diagnosis ?
Abnormal-appearing right paraspinal line in a 27-year-
old patient who had sustained traumatic injur...
Left Paraspinal Line
30
Chest radiograph with superimposed
mediastinal stripes
Light blue
Left paraspinal
stripe
31
Left paraspinal stripe
Contact of
The left
lung
Pleura
Posterior
mediastinal fat
Left
paraspinal
muscles
Adjacent
soft
tis...
Left paraspinal stripe
• The left paraspinal
line extends
vertically from the
aortic arch to the
diaphragm
33
Left paraspinal stripe
• The normal left paraspinal line typically lies medial
to the lateral wall of the descending thora...
Left paraspinal stripe
• Reported on 41% of
PA radiographs
35
Left paraspinal stripe
36
• The left paraspinal line is seen more frequently than
the right paraspinal line due to the pre...
An abnormal contour of the left paraspinal line
Tortuosity Of
The Descending
Thoracic Aorta
Osteophytes
A Mediastinal
Fat
...
An abnormal contour of the left paraspinal line
A Mediastinal
Hematoma
Extramedullary
Hematopoiesis
Esophageal
Varices
38
An abnormal contour of the left paraspinal line
39
• CT scan shows
extensive
esophageal varices
(arrow), which are
respons...
40
The posterior tracheal stripe
41
FranquetT, Erasmus JJ, Gimenez A, Rossi S, Pratts R. The retrotracheal space: normal
anat...
The posterior tracheal stripe
• That is formed by air
within the trachea
and right lung
outlining the
posterior tracheal
w...
The posterior tracheal stripe
• It typically measures
up to 2.5 mm in
thickness
43
ProtoAV, Speckman JM. The left lateral ...
Refresh your
Knowledge
1. ………………
46
Refresh your
Knowledge
1. Trachea
47
Refresh your
Knowledge
2. ………….
48
Refresh your
Knowledge
2. Right
mainstem
bronchus
49
Refresh your
Knowledge
3. ………………
50
Refresh your
Knowledge
3. Left mainstem
bronchus
51
Refresh your
Knowledge
4………………
52
Refresh your
Knowledge
4. Aortic “knob”
or arch
53
Refresh your
Knowledge
5. ………………..
54
Refresh your
Knowledge
5. azygos
vein emptying
into superior
vena cava
55
Refresh your
Knowledge
6. …………………..
56
Refresh your
Knowledge
6. Right
interlobar
pulmonary
artery
57
Refresh your
Knowledge
7. …………………
58
Refresh your
Knowledge
7. Left
pulmonary
artery
59
Refresh your
Knowledge
8. ……………….
60
Refresh your
Knowledge
8. Right upper
lobe pulmonary
artery (truncus
anterior)
61
Refresh your
Knowledge
9. ……………..
62
Refresh your
Knowledge
9. Right inferior
pulmonary vein
63
Refresh your
Knowledge
10…………….
64
Refresh your
Knowledge
10. right atrium
65
Refresh your
Knowledge
11. ……………
66
Refresh your
Knowledge
11. left ventricle
67
Refresh your
Knowledge
01. …………………
68
Refresh your
Knowledge
01.Retrosternal
space
69
Refresh your
Knowledge
02. ……………..
70
Refresh your
Knowledge
02. Ascending
aorta
71
Refresh your
Knowledge
03. …………..
72
Refresh your
Knowledge
03. Aortic arch
73
Refresh your
Knowledge
04. ………………..
74
Refresh your
Knowledge
04. brachiocephalic
vessels
75
Refresh your
Knowledge
05. ………….
76
Refresh your
Knowledge
05. Trachea
77
Refresh your
Knowledge
06. ……………….
78
Refresh your
Knowledge
06. Right upper
lobe bronchus
79
Refresh your
Knowledge
07…………………
80
Refresh your
Knowledge
07. Left upper lobe
bronchus
81
Refresh your
Knowledge
08. ………………
82
Refresh your
Knowledge
08. right
pulmonary artery
83
Refresh your
Knowledge
09. …………………….
84
Refresh your
Knowledge
09. Left pulmonary
artery
85
Refresh your
Knowledge
10. …………………
86
Refresh your
Knowledge
10. confluence of
pulmonary veins
87
The posterior tracheal stripe
• Retro-tracheal
triangle
88
The posterior tracheal stripe
89
thoracic inlet
aortic arch
Why should we distinguish the posterior
tracheal stripe & Retro-tracheal triangle ?
• Franquet et al
observed that the
mos...
Abnormal thickening
of the posterior
tracheal stripe
Acquired vascular
lesions
Esophageal lesions
Lymphatic
malformations
...
Lateral chest
radiograph
Shows widening
of the posterior
tracheal stripe
(arrows)
92
CT scan
Demonstrates a
dilated
esophagus
(arrow) filled
with food and
contrast
material
93
Guess the
Diagnosis ?
Abnormal
posterior
tracheal stripe in
a 49-year-old
patient with
……………………
94
Guess the
Diagnosis ?
Abnormal
posterior
tracheal stripe in
a 49-year-old
patient with
Achalasia
95
96
Chest radiograph with superimposed
mediastinal stripes
Red
Azygoesophageal
stripe
97
Azygoesophageal recess
Not considered a
mediastinal line or
stripe
98
Azygoesophageal recess
An important
mediastinal
interface caused by
differences in
density between the
mediastinum and
the...
CT scan
The
azygoesophageal
recess
represents a
space lying
lateral or
posterior to the
esophagus and
anterior to the
spin...
Mild leftward convexity superiorly
and a straight edge inferiorly
101
Abnormal contour of
Azygoesophageal
recess
Lymphadenopathy
Hiatal hernias
Bronchopulmonary-
foregut
malformations
Esophage...
Abnormal contour of Azygoesophageal recess
• The distal third of
the azygoesophageal
recess demonstrates
an abnormal conto...
Guess the diagnosis
• A large hiatal hernia
104
A large hiatal hernia
• CT scan shows a
large hiatal hernia
(arrow) that causes a
rightward bulge of
the distal
azygoesoph...
Chest radiograph with superimposed
mediastinal stripes
Dark green
Para-aortic line
106
Chest radiograph with superimposed
mediastinal stripes
Brown
pleuroesophageal
stripe
107
108
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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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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