Normal Tracheoesophageal Stripe Thickness on Radiography
The tracheoesophageal stripe is a soft-tissue interface visible on the lateral chest radiograph, formed by the posterior tracheal wall and the adjacent anterior esophageal wall. It represents the combined thickness of these two structures and the intervening fat and connective tissue. Accurate measurement of this stripe is important because focal or diffuse thickening can be an early indicator of posterior mediastinal disease.
Normal Reference Values
| Orientation | Measurement |
|---|---|
| Lateral | <5.5 mm |
Clinical Significance
A tracheoesophageal stripe exceeding 5.5 mm on lateral radiography is considered abnormal and warrants further evaluation, typically with CT. Thickening may be focal or diffuse and can reflect a range of pathological processes involving the trachea, esophagus, or surrounding mediastinal tissues.
Common pitfalls include suboptimal patient positioning producing an oblique lateral projection, respiratory motion, or overlying vascular structures that can artifactually widen the stripe. A true abnormal measurement should be reproducible and corroborated by clinical context.
- Esophageal carcinoma with mural thickening or periesophageal spread
- Posterior mediastinal lymphadenopathy
- Tracheal neoplasm or wall infiltration
- Esophageal leiomyoma or gastrointestinal stromal tumor
- Mediastinitis or abscess
Reference: Coche EE. Medical Radiology / Diagnostic Imaging, Comparative Interpretation of Ct and Standard Radiography of the Chest. Springer Verlag Berlin Heidelberg. p. 113 (2011).
Imaging Notes
On the lateral chest radiograph, the tracheoesophageal stripe is identified as the soft-tissue band posterior to the tracheal air column, extending craniocaudally from the thoracic inlet toward the carina. Measurement is made perpendicular to the long axis of the trachea at the point of greatest apparent thickness. A true lateral projection is essential — even slight rotation can superimpose mediastinal vessels and falsely increase the measured width.
When the stripe appears thickened or irregular on radiography, cross-sectional CT with intravenous contrast is the recommended next step to characterize the abnormality, delineate its extent, and guide further management.