Post on 27-May-2015
description
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail: Qusaibaty@gmail.com
Lines & mediastinal Stripes - 02
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Topic Outline
1. Anterior junction line complex2. Aortic-Pulmonary Stripe3. Right Paraspinal Line4. Posterior Tracheal Stripe
(Tracheoesophageal Stripe)5. Azygoesophageal Recess
Anterior junction line complex
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Chest radiograph with superimposed mediastinal stripes
Purple• Anterior
junction line
complex
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Anterior junction line on PA chest radiograph (arrows)
Note that the line does not extend above the level of the clavicles
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Anterior junction line complex
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Quiz
• What are the signs that you see in chest x-ray?
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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.
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What are the signs that you see in chest x-ray?
• Frontal chest radiograph shows the anterior junction line (arrows) displaced to the right.
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CT scan helps confirm rightward displacement of the anterior junction line (arrow) with volume loss in the right lung.
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Guess the Diagnosis ?
• Abnormal-appearing anterior junction line in a patient who had undergone a right middle lobectomy11
Anterior and posterior junction lines mediastinum
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Aortic-Pulmonary Stripe
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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
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Aortic-Pulmonary Stripe
• The stripe is straight or mildly convex, crossing laterally over the aortic arch and the main pulmonary artery
Aortic-Pulmonary Stripe
• CT scan shows a normal aortic-pulmonary stripe (arrows)
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Aortic-Pulmonary Stripe / Chest x ray
• Abnormal contour of the aortic-pulmonary stripe (arrows)
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Aortic-Pulmonary Stripe
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• CT scan shows anterior mediastinal lymphadenopathy (arrows) within the prevascular space
Guess the Diagnosis ?
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Abnormal-appearing aortic-pulmonary stripe in a 42-year-old patient with lymphoma
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Elevation of the aortic-pulmonary stripe
Pneumomediastinum Anterior mediastinal disease
Thyroid masses
Thymic masses
Prevascular lymphadeno
pathy
KeatsTE. The aortic-pulmonary mediastinal stripe. Am J Roentgenol Radium Ther Nucl Med1972; 116: 107–109
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Right Paraspinal Line
Chest radiograph with superimposed mediastinal stripes
Light blue
Right paraspinal stripe
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Right and left paraspinal stripes (A mediastinal interface )
• It represents an interface between the right lung and the posterior mediastinal fat and soft tissues.
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Right paraspinal stripes
• The right paraspinal line appears straight and typically extends from T8 – T12
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Right paraspinal stripes
• Its presence on 23%
of posteroanterior
radiographs
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The right paraspinal line may be displaced laterally
Osteophytes
A mediastinal fat
A mediastinal hematoma
Abnormal-appearing right paraspinal line in a Frontal chest radiograph
• An abnormal bulge
in the right
paraspinal line
inferiorly (arrows)
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Abnormal-appearing right paraspinal line in CT scan
• An abnormal bulge
in the right
paraspinal line
inferiorly (arrows)
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Guess the Diagnosis ?
Abnormal-appearing right paraspinal line in a 27-year-old patient who had sustained traumatic injury
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Left Paraspinal Line
Chest radiograph with superimposed mediastinal stripes
Light blue
Left paraspinal stripe
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Left paraspinal stripe
Contact of
The left lung Pleura
Posterior mediastina
l fat
Left paraspinal
musclesAdjacent soft
tissues
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Left paraspinal stripe
• The left paraspinal line extends vertically from the aortic arch to the diaphragm
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Left paraspinal stripe
• The normal left paraspinal line typically lies medial to the lateral wall of the descending thoracic aorta.
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Left paraspinal stripe
• Reported on 41% of
PA radiographs
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Left paraspinal stripe
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• 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
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An abnormal contour of the left paraspinal line
Tortuosity Of The
Descending Thoracic
AortaOsteophyt
es
A Mediastina
l Fat
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An abnormal contour of the left paraspinal line
A Mediastinal Hematoma
Extramedullary Hematopoiesis
Esophageal Varices
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An abnormal contour of the left paraspinal line
• CT scan shows extensive esophageal varices (arrow), which are responsible for the abnormal contour of the left paraspinal line.
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Posterior Tracheal Stripe (Tracheoesophageal Stripe)
The posterior tracheal stripe
41FranquetT, 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
The posterior tracheal stripe
• That is formed by air within the trachea and right lung outlining the posterior tracheal wall and intervening soft tissues
42FranquetT, 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
• It typically measures up to 2.5 mm in thickness
43ProtoAV, Speckman JM. The left lateral radiograph of the chest. I.Med Radiogr Photogr1979; 55: 29–74.
Refresh your Knowledge
1. ………………
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Refresh your Knowledge
1. Trachea
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2. ………….
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2. Right mainstem
bronchus
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3. ………………
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3. Left mainstem bronchus
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4………………
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4. Aortic “knob” or arch
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5. ………………..
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5. azygosvein emptying into superior
vena cava
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6. …………………..
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6. Right interlobar pulmonary
artery
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7. …………………
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7. Left pulmonary
artery
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8. ……………….
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8. Right upper lobe pulmonary artery (truncus
anterior)
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9. ……………..
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9. Right inferior pulmonary vein
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10…………….
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10. right atrium
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11. ……………
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11. left ventricle
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01. …………………
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01.Retrosternal space
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02. ……………..
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02. Ascending aorta
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03. …………..
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03. Aortic arch
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04. ………………..
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04. brachiocephalicvessels
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05. ………….
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05. Trachea
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06. ……………….
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06. Right upper lobe bronchus
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07…………………
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07. Left upper lobe bronchus
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08. ………………
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08. right pulmonary artery
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09. …………………….
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09. Left pulmonary artery
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10. …………………
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10. confluence of pulmonary veins
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The posterior tracheal stripe
• Retro-tracheal triangle
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The posterior tracheal stripe
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post
erio
r
trac
heal
strip
e
thoracic inlet
spin
e
aortic arch
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.
Abnormal thickening of the posterior tracheal stripe
Acquired vascular lesions
Esophageal lesions
Lymphatic malformations
Mediastinitis
Post-traumatic hematomas
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Lateral chest radiograph
Shows widening of the posterior tracheal stripe
(arrows)
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CT scan
Demonstrates a dilated
esophagus (arrow) filled with food and
contrast material
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Guess the Diagnosis ?
Abnormal posterior
tracheal stripe in a 49-year-old patient with
……………………
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Guess the Diagnosis ?
Abnormal posterior
tracheal stripe in a 49-year-old patient with
Achalasia
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AZYGOESOPHAGEAL RECESS
Chest radiograph with superimposed mediastinal stripes
Red
Azygoesophageal stripe
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Azygoesophageal recess
Not considered a mediastinal line or
stripe
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Azygoesophageal recess
An important mediastinal
interface caused by differences in
density between the mediastinum
and the posteromedial
portion of the right lower lobe
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CT scan
The azygoesophageal recess represents a space lying lateral or posterior to the
esophagus and anterior to the spine
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Mild leftward convexity superiorly and a straight edge inferiorly
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Abnormal contour of Azygoesophageal recess
Lymphadenopathy
Hiatal hernias
Bronchopulmonary-foregut malformations
Esophageal neoplasms
Pleural abnormalities
Cardiomegaly with left atrial enlargement
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Abnormal contour of Azygoesophageal recess
• The distal third of the azygoesophageal recess demonstrates an abnormal contour and right lateral convexity (arrows)
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Guess the diagnosis
• A large hiatal hernia
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A large hiatal hernia
• CT scan shows a large hiatal hernia (arrow) that causes a rightward bulge of the distal azygoesophageal recess.
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Chest radiograph with superimposed mediastinal stripes
Dark green
Para-aortic line
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Chest radiograph with superimposed mediastinal stripes
Brown
pleuroesophageal stripe
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