Paratracheal stripe

Case contributed by Dr Craig Hacking

Presentation

Cough and weight loss

Patient Data

Age: 25
Gender: Female
Modality: X-ray

Thickening of the right paratracheal stripe with tracheal deviation to the left. Lungs and pleural spaces are clear. Mild splaying of the carinal suggests subcarinal lymphadenopathy. Heart size is within normal limits. No hilar masses.

CT advised for further assessment.

Modality: CT

There is significant mediastinal and cervical lymphadenopathy: 

  • subcarinal mass of soft tissue density measuring 4.6 x 5.9 x 2.8 cm causing mild splaying of the carina.
  • right paratracheal - multiple lymph nodes, largest measuring 1.7cm.
  • Cervical -right level 4 lymph nodes

There is a focal area ground glass opacity with surrounding nodularity in the lateral segment of the left lower lobe. Multiple small pulmonary nodules throughout both lungs affecting all lobes. These are predominantly peripheral without an upper lobe predominance and likely represent granulomas from tuberculosis infection. The airways are normal. The pleural spaces are clear.

No suspicious bony abnormality identified.

Conclusion

  • Subcarinal, right paratracheal and lower right cervical lymphadenopathy. The latter would be ultrasound accessible for FNA.
  • Multiple small pulmonary nodules throughout both lungs.
  • In the clinical context these findings are consistent with tuberculosis lymphadenitis, possibly primary.

Case Discussion

Good example of thickening of the parartracheal stripe. 

Further Hx after the CT: 8 months constitutional symptoms of malaise, lethargy, 15 kg unexplained weight loss, nausea and dry cough. Eritrean refugee.

Positive Quantiferon gold test subsequently.

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Case Information

rID: 36847
Case created: 13th May 2015
Last edited: 3rd Sep 2015
System: Chest
Inclusion in quiz mode: Included

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