Right paratracheal stripe

Last revised by Dr Sonam Vadera on 03 Feb 2021

The right paratracheal stripe is a normal finding on the frontal chest x-ray and represents the right tracheal wall, adjacent pleural surfaces and any mediastinal fat between them. It is visible because of the silhouette sign created by air within the trachea medially and air within the lung laterally.

It normally measures less than 4 mm 1,2 and thickening is non-specific but may represent 3:

Recognition of any abnormality in the right paratracheal stripe is invaluable in ensuring the appropriateness in further investigation with CT 1.

Radiographic features

Plain radiograph
  • seen in ~90% (range 83-97%) of normal PA chest x-rays 2,3
  • appears as a stripe that extends from the level of the clavicles to the right tracheobronchial angle at the level of the azygous arch
  • is usually in continuity with the right-sided great vessels superiorly and azygos vein inferiorly

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Cases and figures

  • Case 1 : normal radiograph
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  • Case 2 : apparent widening due to rotation
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  • Case 3: thickened due to metastatic mediastinal lymphadenopathy
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  • Case 4: widening from lymphoma
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  • Case 5: paratracheal lymphadenopathy
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