What Causes Enlargement Of Hilar Nodes?

Posted on Wed, 4 Mar 2015

Question: My 3 yr old with hx of RAD was seen in ER at 1200 Tues. She was Dg with Viral Pneumonitis, no hypoxia, 8 rib inflation with mild streaking but no focal infiltrate. There is hilar adenopathy (doesn't specify in my take home instructions whether it's right, left or mediastinal) suggesting inflammation which they said should be improved with Decadron 8 mg IM (given in ER) and 8 mg po dosing at home (given last night). We are to continue with azithromycin prescribed on Sunday for bilater ear and eye infections and her normal asthma meds. I have worked as a PICU nurse and I know that hilar adenopathy is typically caused by pathogens she wouldn't have been exposed too here in CO but that it can also be lymphoma so I am having great anxiety. My question is can a stand pediatric virus, or asthma cause those nodes to enlarge temporarily? ie RSV or flu (none of which they tested for). She has repeat films next week. I am looking for some peace of mind in the mean time.

Answered by Dr. Satyadeo Choubey (53 minutes later)

Brief Answer:
viruses can cause. So wait and watch.

Detailed Answer:
Thanks for the query.
Enlarged hilar nodes may be caused by several set of infections including chronic granulomatous conditions like tuberculosis or fungal infections. Viral infections like influenza or EBV though chiefly involve cervical nodes may cause generalised lymphadenopathy including the hilar.
Malignancies like lymphoma may cause the same.
One must correlate it clinically. In your case there is obvious manifested respiratory tract infection. So it will be wise choice to get a follow up chest X ray after the subsidence of the infection.
If it persists and child is symptomatic you can opt for CT thorax to have the exact number and location of the node. Hopefully they will get resolve the infection itself.

Best wishes

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Satyadeo Choubey (39 minutes later)

Since it seems to be posed rather insignificantly in the Dg section and the children have been passing colds around frequently these past three weeks, there were no sputum cultures taken I am hoping the likelihood of lymphoma is small although I am scared to death. Would you recommend any f/u at Jewish National now during her clinical symptoms to get tests done for flu, EBV etc or TB or for fungus? We have not been seen there but they are one of the best in the nation.

I didn't see the part where you said viral etiology can be the cause so we will wait and watch...although I am still terrified. Thank you!

Answered by Dr. Satyadeo Choubey (10 minutes later)

Brief Answer:
Don't get panic

Detailed Answer:
Thanks for follow up.
You said you are a health professional in the form of nurse. Our job is to understand the situation not getting terrified.

If TB is common there you can get simple blood test called IGRA done. But the best is again waiting for 2 weeks if your child is responding to the treatment. I.e she is getting afebrile , accepting feeds, is not breathless or wheezing.

Best wishes

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj