Type:
Educational Exhibit
Keywords:
Neoplasia, Normal variants, CT, Conventional radiography, Oncology, Mediastinum, Anatomy
Authors:
N. Bystrická, H. Poláková, J. Sykora; Bratislava/SK
DOI:
10.1594/ecr2013/C-0442
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 interfaces,
or edges,
are produced by contact between aerated lung and adjacent mediastinal structures.
The mediastinal interfaces include the right and left paraspinal lines,
the azygoesophageal recess,
the aortic pulmonary stripe,
the paraortic line and cardiac borders.
The frequency of visualization of these reflections on chest radiographs is variable (Table 1),
therefore the absence of one of the mediastinal lines,
stripes or interfaces may be insignificant as it may be caused by anatomic variations or by technical conditions.
However,
presence,
obliteration,
thickening or distortion of these lines,
stripes and edges can reveal mediastinal disease. These findings can be also used to localize mediastinal masses in the anterior,
middle or posterior mediastinum (Table 2) and therefore may help narrow the differential diagnosis (Table 3) and determine the most appropriate further diagnostic workup.
Abbreviations:
PA = posteroanterior
CT = computed tomography
Cor MPR = coronal multiplanar reconstruction
Sag MPR = sagittal multiplanar reconstruction
SVC = superior vena cava
IVC = inferior vena cava
AP = aortic-pulmonary
LN = lymph nodes