What Do The Following Chest X-ray Reports Indicate?

Posted on Tue, 6 Oct 2015

Question: Hello Doctor,

I had a yearly chest X-ray and was reported some issues. Because of it I had a second chest X-ray after 2 months.

Here I am presenting what was reported.

Findings from 1st X-ray: PA, lateral show normal heart size and mediastinum. There is stable borderline mild central hilar fullness. Normal peripheral pulmonary vessels. No infiltrate or pleural fluid. 6 mm retrosternal density projects over cardiac apex on lateral view, not seen on previous underpenetrated study.

Impression:

1. Persistent borderline mild central hilar fullness which is nonspecific although can be seen with pulmonary arterial hypertension; correlate clinically.

2. 6 mm retrosternal density, possible pulmonary nodule. Unless this can be shown to be stable on old films for at least 2 years, could consider limited noncontrast CT to exclude nodule if indicated.

Follow Up X-Ray after 2 months
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Technique/Findings: PA and lateral erect views with comparision study of 7/14/2015 show normal heart size. Bilateral central hilar prominence similar to previous. No parenchymal infiltrate or effusion. Retrosternal opacity on prior exam is no longer present and may have been related to costochondral calcification. Thoracic spine mild degenerative changes.

Impression:

1. Bilateral central hilar prominence without significant change. Considerations include pulmonary arterial hypertension, hilar lymphadenopathy or central masses. Chest CT is indicated for intial further assessment.

It would be great if you can let me know if there are any things to be concerned about .. and what are the next steps I need to take.

Thanks

Answered by Dr. Drkaushal85 (4 hours later)

Brief Answer:
Get done CT thorax.

Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Both x rays are suggestive of hilar prominence.
Lung hilum is made up of bronchus, blood vessels, lymphnodes, lymphatic vessels etc.
So prominence of lung hilum suggest possibility of pathology in either of them.
Chest x ray is not good at differentiating between these hilar structures.
And therefore CT thorax is necessary.
So better to get done CT thorax with Contrast to determine hilar pathology.
Sometimes, without any pathology, hilum can be prominent.
So if you are asymptomatic or nonsmoker with normal CT thorax report than no need to worry for hilar prominence on chest x ray.
But if CT shows pathology in either bronchus (mass), lymphnode (enlargement), blood vessels (Pulmonary hypertension) than further investigations are needed.
So at present get done CT thorax.
Hope I have solved your query.
I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Drkaushal85 (2 hours later)

Thanks Doctor for the quick reply. What might be the reasons which cause it?

We live in cold weather in US and hence I get lot of colds each year.. Can it cause these type of issues?

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
Infection is the most common cause.

Detailed Answer:
Thanks for your follow up question on HCM.
I can understand your concern.
Following are the common causes for hilar enlargement.
1. Infections like tuberculosis, pneumonia etc.
2. Lymphadenopathy like lymphoma
3. Sarcoidosis
4. Pulmonary hypertension.
In cold weather possibility of infections, sarcoidosis and Pulmonary hypertension is more.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Sonia Raina