Revision 2 for 'Assessment of pulmonary hila on chest x-ray (approach)'

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Assessment of hill on CXR

Described here are points on assessment of hila on chest radiographs.


1. Shape
  • normally appear as gentle C shapes on either side without lumps or bumps
  • contents: pulmonary arteries + veins, bronchi, lymph nodes
2. Position
  • left hila is normally (< 2cm) higher than the right
  • a low left/right hilum could mean that it is either pushed/pulled up or down
3. Size - Nodal vs. Vascular enlargement
  • vascular enlargement - appear like ‘elephants’ trunks, bilateral
  • nodal enlargement - appears craggy. May be due to rotation or skeletal abnormality (scoliosis). Beware: the lesion may not be in the hila
4. Interval change
  • for any suspected pathology, comparison to previous imaging is the first step to further evaluation

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