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| TEACHING IMAGES |
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| Year : 2013 | Volume
: 1
| Issue : 2 | Page : 195-196 |
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Thickened and bulging left paratracheal stripe: Is it always abnormal?
Chandrashekhar A Sohoni
Department of Radiology, NM Medical, Kalyani Nagar, Pune, Maharashtra, India
| Date of Web Publication | 13-Dec-2013 |
Correspondence Address:
Chandrashekhar A Sohoni
B-5, Common Wealth Hsg. Soc., Opp. Bund Garden, Pune - 411 001, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.123053
How to cite this article:
Sohoni CA. Thickened and bulging left paratracheal stripe: Is it always abnormal?. Arch Med Health Sci 2013;1:195-6 |
| Case Report | |  |
A 31-year-old, asymptomatic male presented for a chest radiograph as a part of routine check-up. An abnormal bulge was noted along the left mediastinal contour [Figure 1], which appeared to be due to the thickening of the left paratracheal stripe (LPS). A CT scan of chest was performed to exclude any mediastinal pathology. The CT scan showed a left-sided aortic arch with a further mild left-ward tilt [Figure 2], and the superior mediastinal fat interposed between the ascending and proximal descending aorta [Figure 3]. A combination of these factors was responsible for the appearance of an apparently abnormal bulge of the left mediastinal contour on the radiograph. No evidence of any other mediastinal abnormality was seen on CT scan.  | Figure 1: The chest radiograph reveals thickening and bulging of left paratracheal stripe
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 | Figure 2: The CT image shows left-ward tilt of the descending portion of the aortic arch
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 | Figure 3: The CT image shows the mediastinal fat interposed between the ascending and proximal descending aorta
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The LPS is formed by the contact of left upper lobe and either the mediastinal fat adjacent to the left tracheal wall or the left tracheal wall itself. [1] The stripe extends superiorly from the aortic arch to join with the reflection from the left subclavian artery. The LPS is seen less frequently than the right paratracheal stripe. Abnormal contour or widening of LPS is commonly seen in large left-sided pleural effusions, in addition to left paratracheal lymphadenopathy, neoplasm, or mediastinal hematoma. [2] Hence, in addition to the usual differential diagnosis, a possibility of a left-ward tilted but otherwise normal aortic arch needs to be kept in mind while looking at the thickening of the left paratracheal stripe.
| References | | |
| 1. | Proto AV. Mediastinal anatomy: Emphasis on conventional images with anatomic and computed tomographic correlations. J Thorac Imaging 1987;2:1-48. 
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| 2. | Gibbs JM, Chandrashekhar CA, Ferguson EC, Oldham SA. Lines and stripes: Where did they go? - From conventional radiography to CT. Radiographics 2007;27:33-48.
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[Figure 1], [Figure 2], [Figure 3]
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