How to Read a Chest X-Ray: Mediastinal Lines, Stripes & Interfaces

[@Solidbody]

Thank you for your hard work in educating the world!

[@radiologyframeworks]

So glad to hear these videos are helpful. Thanks!!

[@theneuroradiologist]

nice videos, they way you approach the subject is great and very educatonal! you also have a nice voice to listen to if you don't mind me saying

[@radiologyframeworks]

Thanks for the kind compliment. It means a great deal, coming from an outstanding educator like you!

[@MrCash62]

If I understand correctly, the right paratracheal stripe only corresponds to the right tracheal wall and not to the right paratracheal tissues The examples which you showed regarding the right paratracheal stripe showed rather a widening of the right paratracheal tissues I think. Maybe you could elaborate further on this ?. Thanks for the great video.

[@radiologyframeworks]

The September 2023 Radiographics article, "3D Visual Guide to Lines and Stripes in Chest Radiography" by Jiao et al. is an easy to read review article on this particular subject, and one I often recommend to my residents. Our teaching has been that the right paratracheal stripe consists of medial right pleura tissue, right lateral tracheal wall, and the right paratracheal fat in between. Jiao et al. appear to agree, and describe the right paratracheal stripe as "formed by contact of the right upper lobe visceral and parietal pleurae with the right lateral border of the trachea" (which would include the small amount of right paratracheal fat between the pleura and tracheal wall). Jiao et al. also describe the stripe as projecting "from the level of the right clavicle to the right tracheobronchial angle". If we peek at the CT of a "normal" patient, the superior to mid segment of the right paratracheal stripe is mostly attributable to the right lateral tracheal wall since the pleural layers are microscopically thin, and the right paratracheal fat between the tracheal lumen and pleura is also minimal. As we move more inferiorly, there's more right paratracheal fat contributing to the stripe's thickness. Hope that helps!

[@MrCash62]

@@radiologyframeworks At the example which you show @13:14 the right paratracheal stripe is shown as thin highlighted red line which is not a part of the right mediastinal sillhoute. The paratracheal tissues which form the mediastinal contour are excluded from this But at the example @14:52 you show the thick red-highlighted stripe forming the contour of the mediastinum. In my opinion, in this case the right stripe is still perceivable as a thin white line forming the wall of the trachea. As a summary I think there should be made a distinction between a thickening of the right paratracheal stripe and a thickening of the right paratracheal tissues. Do you make such a distinction?

[@radiologyframeworks]

On the CXR @13:14, there is indeed additional right mediastinal tissue that exists lateral to (and therefore excluded from) the right paratracheal stripe. The mediastinal contour *is* situated around 1 cm lateral to the right paratracheal stripe. However, what forms this contour is mostly right *prevascular* mediastinal tissue and ascending aorta/proximal aortic arch (anterior to the more medially situated anatomy responsible for creating the right paratracheal stripe) rather than right paratracheal mediastinal tissue. On the CXR @14:52, I think I see what you mean. I agree there is a white band that does look a lot like right tracheal wall when I view the CXR in KZbin too, though it's less convincing if you're viewing the actual Keynote slide instead of a compressed video of it. I'll post a PNG in the Community tab of this KZbin channel so you can see the actual image, too. With regards to your question, I'd say that a distinction should be made between thickening of the right paratracheal stripe and thickening of the right mediastinal tissues. Implicit in this are (1) the right paratracheal stripe is a proxy for the right paratracheal tissues and (2) the right paratracheal tissues are a subset of the right mediastinal tissues; e.g. the right prevascular tissues are right mediastinal tissues but distinct from the right paratracheal tissues.