Have Occasional Cough And Congestion Feeling. What Does The Chest X-ray Report Indicate?

Posted on Tue, 3 Dec 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 3 Dec 2013 Answered on

Thu, 26 Dec 2013 Last reviewed on

Question : X-RAY CHEST PA VIEW : RADIOLOGICAL FINDINGS : Bony cage is normal. Trachea is central. Cardiac silhouette is normal in shape and size. Both domes are normal in anatomy. Both cp angles are clear. Right hilar shadow is bulky. No other lung lesion is seen. IMPRESSION :- Bulky Right Hilum. Suggest Clinicopathological Correlation. What do you think about this xray report? I had cough but now no more except occasionally but I do have congestion feeling but no other symptoms

Answered by Dr. Gyanshankar Mishra (7 hours later)

Brief Answer: HRCT scan will confirm the cause of bulky hilum Detailed Answer: Hi, Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following: 1. The Xray chest is suggestive of bulky right hilum. 2. The causes of bulky right hilum could be right hilar adenopathy, right hilar mass or prominent bronchovascular markings on right side. 3. Clinically you have symptoms of recurrent allergic rhinitis with GERD. Both are strong risk factors for chronic cough. Do you have any associated breathlessness? 4. You need to take medications for control of rhinitis as well as GERD. For the cough a 2 to 3 weeks of antibiotic course is recommended. Investigations required include Serum IgE, Sputum examination and HRCT scan thorax. HRCT scan of the thorax will lead to the exact cause of bulky hilum. Most commonly it could be lymphadenopathy due to associated infection. 5. If there is associated breathlessness, then PFT may be required. Any associated Obstructive airway disease/ hyper responsive airways needs to be ruled out. 6. A detailed evaluation by a Pulmonologist is recommended. 7. At this moment, the clinical picture seems to be of Upper airway cough syndrome /bronchitis. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (8 minutes later)

What would you recommend? What should I take for my allergies? What should take I take for GERD? What kind of antibiotic? I do not have breathlessness. But I do have a congestion feeling though no cough except I feel like coughing. I had another x-ray taken but it shows bilateral hilar shadows are normal. I am sorry I completely forgot to tell that I do take medicine called Tazloc Am which is a combination of telmisartan 40mg and amlodopine 5mg.

Answered by Dr. Gyanshankar Mishra (1 hour later)

Brief Answer: Repeat Normal Xray is good Detailed Answer: Hi, Thanks for the follow up. After going through the follow up, I would like to comment the following: 1. The previous hilar shadow could have been due to film rotation which is very common. Now that your repeat Xray does not show any hilar adenopathy is good news. 2. You seem to be suffering from UACS (Upper airway cough syndrome). 3. For controling cold, medications of the class of antihistamines and leukotriene inhibitors like combination of montelukast and fexofenadine are prescribed to patients. Sometimes anti cold Nasal sprays (Azelastine/ fluticasone) are really helpful in such conditions.Avoidance of allergens is very important. For GERD medications of the class proton pump inhibitors eg. Cp. Pantoprazole 40 mg empty stomach in morning help. Also life style modifications like not remaining hungry for more than 4 hours, avoiding spicy diet etc. are important. A 2 week course of antibiotic like Augmentin (Amoxicillin +clavulinic acid 625 mg) thrice daily is generally recommended. You thus need to visit a Pulmonologist and get all the required medications prescribed as per clinical evaluation. 4. Once the symptoms have subsided , you need to take flu shots yearly considering your allergic symptoms and also pneumococcal shots every 5 yearly. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar