Assessment of pulmonary hila on chest x-ray (approach)

Changed by Henry Knipe, 6 Aug 2018

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Title was changed:
Assessment of pulmonary hila on CXRchest x-ray (approach)
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Described here are points on to consider when approaching the assessment of thepulmonaryhila on chest radiographs.x-ray:

Hila
  • shape

1. Shape
  • normally appear as gentle C shapes-shapes on either side without lumps or bumps
  • contents: pulmonary arteries +and veins, bronchi, lymph nodes
2. Position
  • position
    • left hila ishilum is normally (< 2cm)1-2cm higher than the right
    • a low left/right hilum could mean that it is either pushed/pulled up or downdisplaced, usually due to volume loss in atelectasis
    3. Size - Nodal vs. Vascular enlargement
  • size
    • vascular enlargement -: appear like ‘elephants’"elephants trunks", bilateraltypically bilaterally enlarged
    • nodal enlargement -: appears craggy. May be; maybe due to rotation or skeletal abnormality (scoliosis)(e.g. Beware: the lesionscoliosis)
    • an apparent hilar mass may not be hilar in the hilaorigin (see: hilum overlay sign)
    4. Interval change
    • change: for any suspected pathology, comparison to previous imaging is the first step to further evaluation
    • -<p>Described here are points on assessment of <strong>hila on chest radiographs.</strong></p><h4>Hila<strong> </strong>
    • -</h4><h5>1. Shape</h5><ul>
    • -<li>normally appear as gentle C shapes on either side without lumps or bumps</li>
    • -<li>contents: pulmonary arteries + veins, bronchi, lymph nodes</li>
    • -</ul><h5>2. Position</h5><ul>
    • -<li>left hila is normally (&lt; 2cm) higher than the right</li>
    • -<li>a low left/right hilum could mean that it is either pushed/pulled up or down</li>
    • -</ul><h5>3. Size - Nodal vs. Vascular enlargement</h5><ul>
    • -<li>vascular enlargement - appear like ‘elephants’ trunks, bilateral</li>
    • -<li>nodal enlargement - appears craggy. May be due to rotation or skeletal abnormality (scoliosis). Beware: the lesion may not be in the hila</li>
    • -</ul><h5>4. Interval change</h5><ul><li>for any suspected pathology, comparison to previous imaging is the first step to further evaluation</li></ul>
    • +<p>Described here are points to consider when approaching the <strong>assessment of the</strong> <strong>pulmonary</strong> <strong>hila on chest x-ray</strong>:</p><ul>
    • +<li>
    • +<strong>shape</strong><ul>
    • +<li>normally appear as gentle C-shapes on either side</li>
    • +<li>contents: pulmonary arteries and veins, bronchi, lymph nodes</li>
    • +</ul>
    • +</li>
    • +<li>
    • +<strong>position</strong><ul>
    • +<li>left <a title="Pulmonary hilum" href="/articles/pulmonary-hilum-2">hilum</a> is normally 1-2cm higher than the right</li>
    • +<li>low left/right hilum could mean that it is either displaced, usually due to volume loss in <a title="Atelectasis" href="/articles/lung-atelectasis">atelectasis</a>
    • +</li>
    • +</ul>
    • +</li>
    • +<li>
    • +<strong>size</strong><ul>
    • +<li>vascular enlargement: appear like "elephants trunks", typically bilaterally enlarged</li>
    • +<li>nodal enlargement: appears craggy; maybe due to rotation or skeletal abnormality (e.g. scoliosis)</li>
    • +<li>an apparent hilar mass may not be hilar in origin (see: <a title="Hilum overlay sign" href="/articles/hilum-overlay-sign">hilum overlay sign</a>)</li>
    • +</ul>
    • +</li>
    • +<li>
    • +<strong>change</strong>: for any suspected pathology, comparison to previous imaging is the first step to further evaluation</li>
    • +</ul>

    References changed:

    • 1. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

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    • Approach

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