Lauren Brown, MD
Expert reviewer: David Godwin, MD (University of Washington, Department of Radiology)
Objectives
- Differentiate hilar lymphadenopathy from enlarged pulmonary arteries in a patient with pulmonary sarcoidosis.
Teaching Instructions
Plan to spend 5-10 minutes familiarizing yourself with the animations of the PowerPoint and the key findings of this chest X-ray.
Present the image either by expanding the window (bottom right) in a browser or downloading the PowerPoint file (recommended for optimal function). Have the image pulled up in presenter mode before learners look at the screen to avoid revealing the diagnosis. Ask a learner to provide an overall interpretation. Then advance through the animations to prompt learners with key questions and reveal the findings, diagnosis, and teaching points.
CXR Read: The hilum has lobulated densities on both sides, consistent with bilateral hilar lymphadenopathy.
Diagnosis: Sarcoidosis with bulky hilar lymphadenopathy.
Teaching: the hilum consists of blood vessels (pulmonary arteries and veins) and the main bronchi of the lung. On CXR, “hilar points” are the angles (which look like horizontal ‘vees’) formed by pulmonary arteries sloping down and pulmonary arteries sloping up. The fact that these opacities do not taper (look more like potatoes) tells you this is lymphadenopathy, not pulmonary hypertension
On a normal CXR, hilar lymph nodes cannot be seen. When there are enlarged lymph nodes, they will disrupt the normal appearance of the hilar point and will appear as lumpy bumpy opacities.
Common causes of hilar lymphadenopathy include inflammation (sarcoidosis, silicosis), neoplasm (lymphoma, metastases, bronchogenic carcinoma), and infection (TB, infectious mono).
Presentation Board
Take Home Point
- Hilar lymphadenopathy is identified by disruption of the “Hilar Point” with a lumpy-bumpy opacity that does not taper.
- Common causes of hilar lymphadenopathy include inflammation (sarcoidosis, silicosis), neoplasm (lymphoma, metastases, bronchogenic carcinoma), and infection (TB, infectious mono).
References
McLoud, Boiselle, & Boiselle, Phillip M. (2010). Thoracic radiology : The requisites (2nd ed., Requisites in radiology). Philadelphia: Mosby/Elsevier.
