Enlargement of the Hila

Checklist:

Enlargement of the Hila

• Is the enlargement unilateral or bilateral?

• Does the hilum in question have a lobulated configuration?

• Are there any hilar calcifications?

• Are there associated pulmonary parenchymal changes (fibrosis, micronodules)?

• Does the mass pulsate during fluoroscopy?

Just a Few Excess Curves

Hillary Frimpton (42) has called upon her doctor because she has felt unwell for several days and has been suffering from a dry cough. Her doctor has sent her for a chest radiograph. Paul and Giufeng cover the chest imaging unit as Mrs. Frimpton's image pops up on the viewing monitor (Fig. 6.73). The hilar enlargement is obvious.

^ What Is Your Diagnosis?

Sarcoidosis, lymphoma, tuberculosis, silicosis: Bilateral hilar lymph node enlargements can be caused by sarcoidosis, lymphoma, tuberculosis, and silicosis. It is the additional findings—clinical and radiological—that help differentiate these entities. In sarcoidosis interstitial micronodules are often present in the lung (see Fig. 6.48a, b). In lymphoma lymph nodes in other locations are also frequently enlarged (see Fig. 6.59). Tuberculosis must be considered particularly in immunosuppressed patients and patients who come from underdeveloped countries. In silicosis the enlarged lymph nodes tend to develop characteristic calcifications (see Fig. 6.46a).

A unilateral enlargement of a hilum is indicative of a bronchial carcinoma until proven otherwise (Fig. 6.74).

Pulmonary hypertension: Pulmonary hypertension, for example, as a consequence of pulmonary fibrosis or severe chronic obstructive airways disease (Fig. 6.75), triggers dilation of the pulmonary artery as a reaction to the increased vessel resistance. The hila become enlarged accordingly. A contrast-enhanced CT will easily verify the purely vascular nature of the increase in hilar size.

• Diagnosis: Paul checks the CXR very carefully but cannot find any evidence of pulmonary fibrosis or emphysema. The bilateral hilar enlargement is most likely caused by enlarged lymph nodes. Giufeng hopes for sarcoidosis as a cause and the odds are in her favor. If other clinical parameters do not support this diagnosis, a tissue sample will have to be taken—best by way of a bronchoscopy.

I The Case of Hillary Frimpton

I The Case of Hillary Frimpton

Bilateral Hilar Lymph Nodes
Fig. 6.73 What diseases do you think of when looking at Mrs. Frimpton's films?

I Bronchial Carcinoma

I Bronchial Carcinoma

Overinflated

I Pulmonary Hypertension

Lung Hilar Calibre

Fig. 6.75 The lungs are massively overinflated and the diaphragms are flattened accordingly; the vessels show an irregular course. This is severe emphysema that has led to pulmonary hypertension. The pulmonary artery is consequently dilated and there is a significant step in vascular caliber between the hilum and the lung parenchyma.

Fig. 6.75 The lungs are massively overinflated and the diaphragms are flattened accordingly; the vessels show an irregular course. This is severe emphysema that has led to pulmonary hypertension. The pulmonary artery is consequently dilated and there is a significant step in vascular caliber between the hilum and the lung parenchyma.

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Responses

  • sinit gabriel
    What is hila enlarged?
    5 years ago

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