Assessment of pulmonary hila on chest x-ray (approach)

Last revised by Craig Hacking on 18 Feb 2024

The assessment of the pulmonary hila on chest x-ray is important for detecting potential mediastinal and lung pathology.

Several features of the hilum and hilar point can be assessed:

  • shape

    • normally appear as K or C-shapes on either side

    • contents: pulmonary arteries and veins, bronchi, lymph nodes

  • position

    • left hilum is normally 1-2 cm higher than the right

    • low left/right hilum could mean that it is either displaced, usually due to volume loss in atelectasis

  • size

    • vascular enlargement: appear like "elephants trunks", typically bilaterally enlarged

    • nodal enlargement: appears craggy; maybe due to rotation or skeletal abnormality (e.g. scoliosis)

    • an apparent hilar mass may not be hilar in origin (see: hilum overlay sign)

  • change: for any suspected pathology, comparison to previous imaging is the first step to further evaluation

  • density: pathological hila are often more dense/solid

See also

Systematic chest radiograph assessment:

  1. projection

  2. assessment of the technical adequacy

  3. tubes and lines

  4. cardiomediastinal contours

  5. hila

  6. airways, lungs and pleura

  7. bones and soft tissue

  8. review areas

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