Dr. Flip Otto
Dept. of Radiology
Universitas Academic Hospital

• Mediastinal devisions
• Content of mediastinum
• Mediastinal contours on PA chest radiograph
• Cross sectional anatomy of mediastinum
• Mediastinal lines and stripes on conventional radiography and
CT correlation
• Mediastinal spaces
• Mediastinal lymphnodes

Devisions used to describe location of pathological processes:
• Superior mediastinum:
• Above line from lower border
T4 to sternal angle
• Anterior mediastinum:
• Between anterior part of heart and sternum
• Middle mediastinum:
• Occupied by heart and its vessels
• Posterior mediastinum:
• Between posterior part of heart and thoracic spine

3 5 6
1
4
7
2
1-trachea
4-left brachiocephalic vein
6-left common carotid artery
2-oesophagus 3-right braciocephalic vein
5-right brachiocephalic artery
7-left subclavian artery

4
5 1 2
3
1-trachea
4-superior vena cava
2-aortic arch
5-arch of azygos vein
3-oesophagus

7
3
2
6
10
9
8
1
11
5
12
4
1-main pulmonary trunk 2-right pulmonary artery 3-ascending aorta
4-descending aorta
7-superior vena cava
5-left main bronchus
8-oesophagus
10-azygoesophageal recess 11-left superior pulmonary vein
6-right main bronchus
9-azygos vein
12-left descending lower-lobe artery

3 1
2
6
4
5
7
1-aortic root
4-left atrium
7-azygos vein
2-right ventricular outflow tract
5-descending aorta
3-right atrial appendage
6-oesophagus

1 5
2
3
7
8
6
4
1-right atrium
4-left ventricle
6-descending aorta
2-right ventricle 3-left atrium
5-left ventricular outflow tract and aortic valve
7-oesophagus 8-azygos vein

3 4
1
2
5
1-descending aorta
4-oesophago-gastric junction
2-fundus of stomach 3-inferior vena cava
5-spleen

• Lines:
• Anterior junction line
• Posterior junction line
• Stripes:
• Right paratracheal stripe
• Left paratracheal stripe
• Posterior tracheal stripe
• Posterior wall of bronchus intermedius
• Interfaces:
• Right paraspinal line
• Left paraspinal line
• Aortic-pulmonary stripe
• Azygo-oesophageal recess

Volume loss in right lung with rightward displacement of anterior junction line following a right middle lobectomy

Widening of right paratracheal stripe caused by a large ectopic parathyroid adenoma. Note diffuse osteopenia from hyperparathyroidism.

Widening of left paratracheal stripe with mass effect on the trachea due to large thyroid carcinoma and associated supraclavicular lymphadenopathy

Widening of the posterior tracheal stripe due to dilated esophagus in a patient with achalasia.

Diffuse bandlike thickening of the posterior wall of the bronchus intermedius in a patient with pulmonary oedema.

Abnormal bulge in right paraspinal line inferiorly due to mediastinal hematoma from multiple right sided transverse process fractures and an associated hemothorax.

Focal lateral bulge in left paraspinal line due to extensive esophageal varices in patient with liver cirrhosis.

Abnormal contour of the aortic-pulmonary stripe due to lymphoma with anterior mediastinal lymphadenopathy within the prevascular space.

Abnormal contour and right lateral convexity of distal third of azygoesophageal recess due to a large hiatal hernia.

• Four named spaces surrounding the central airways:
• Pretracheal space
• Aortopulmonary window
• Subcarinal space
• Right paratracheal space

Abnormal bulge in AP window due to significant soft tissue mass within AP window and subcarinal space compatible with metastatic lymphadenopathy in a patient with bronchogenic carcinoma. Also widened right paratracheal stripe due to lymphadenopathy and left lower lobe consolidation.

• American Thoracic Society definitions of regional lymph node stations
• X
• 2R
• 2L
• 4R
• 4L
• 5
• 6
• 7
Supraclavicular nodes
Right upper paratracheal nodes
Left upper paratracheal nodes
Right lower paratracheal nodes
Left lower paratracheal nodes
Aortopulmonary nodes
Anterior mediastinal nodes
Subcarinal nodes
• 8
• 9
• 11
Paraesophageal nodes
Right or left pulmonary ligament nodes
• 10R Right tracheobronchial nodes
• 10L Left tracheobroncheal nodes
Intrapulmonary nodes

• Traditional frontal and lateral chest radiography remains a valuable tool in the evaluation of chest disease despite increased reliance on CT, therefore familiarity with anatomic basis of mediastinal lines and stripes as seen on radiography imperative.
• Knowledge of normal anatomic structures within different mediastinal divisions helps guide formulation of appropriate differential diagnosis

• Butler, P., Mitchell, A.W.M., Ellis, H. (1999). Applied Radiological
Anatomy. Cambridge: Cambridge University Press
• Ellis, H., Logan, B.M., Dixon, A.K. (2007). Human Sectional
Anatomy – Atlas of body sections, CT and MRI images, 3 rd ed.
London: Hodder Arnold
• Gibbs, J.M., Chandrasekhar, C.A., Ferguson, E.C. et al. (2007).
Lines and Stripes: Where did they go? – From Conventional
Radiography to CT. Radiographics, 27:33-48.
• Netter, F.H. (2011). Atlas of Human Anatomy, 5 th ed.
Philadelphia: Saunders Elsevier
• Ryan, S., McNicholas, M., Eustace, S. (2011). Anatomy for diagnostic imaging, 3 rd ed. London: Saunders Elsevier