Learning objectives
• to illustrate the anatomical basis of the mediastinal lines,
stripes and interfaces
• to outline normal and pathologic conditions that may alter the appearance of these reflections
• to give examples of the radiographic findings that help localize abnormalities in the anterior,
middle or posterior mediastinum
Background
A variety of mediastinal reflections can be identified at conventional radiography (Fig. 1)
These reflections represent mediastinal lines,
stripes and interfaces.
• mediastinal lines are thin (<1mm in width) linear opacities that result from contact between two aerated structures outlining thin intervening tissue on both sides,
such as the anterior and posterior junction lines.
• mediastinal stripes are bands that result from air outlining thicker intervening mediastinal structure.
The mediastinal stripes present on PA chest radiographs include the right and left paratracheal stripes.
• mediastinal...
Imaging findings OR Procedure details
1.
Anterior Junction Line
Anatomy:
Anterior junction line results from the anterior apposition of the lungs,
which lies behind the upper two-thirds of the sternum.
The line consists of four layers of pleura and a variable amount of intervening fat.
Normal radiographic appearance:
Anterior junction line appears as a thin oblique line projecting over the superior two-thirds of the sternum and runs from the upper right to the lower left.
It does not extend above the level of clavicles.
(Fig. 2).
Abnormal radiographic appearance:
It...
Conclusion
Despite the two dimensional representation of mediastinal structures,
the PA chest radiograph is a powerful tool in diagnosis of mediastinal diseases and it can be used to localize the detected abnormality in the anterior,
middle or posterior mediastinum.
It is important for a radiologist to have an understanding of the concept of mediastinal reflections in order to detect an unsuspected mediastinal mass and avoid potential diagnostic mistakes.
References
1.
Whitten CR,
Khan S,
Munneke GJ et al.
A diagnostic approach to mediastinal abnormalities.
Radiographics 2007; 27: 657–671.
2.
Gibbs JM,ChandrasekharCA,FergusonEC,OldhamSAA.
Lines and Stripes: Where Did They Go? – From Conventional Radiography to CT.
RadioGraphics 2007; 27: 33-48.
3.
Hansell DM,
Bankier AA,
MacMahon H,McLoud TC,Müller NL,
Remy J.
Fleischner Society: glossary of terms for thoracic imaging.
Radiology 2008,
246(3):697-722.
4.
Feragalli B,
Mantini C,
Patea RL,
De Filipps F,
Di Nicola E,
Storno ML.
Radiographic evaluation of mediastinal lines as a diagnostic approach...
Personal Information
MUDr.
Nadežda Bystrická,
MUDr.
Hana poláková,
MUDr.
Juraj Sýkora
Department of radiology
Národný Onkologický Ústav
Klenová 1,
833 10 Bratislava
Slovakia
[email protected]