Hilum convergence sign
Citation, DOI, disclosures and article data
At the time the article was created Andrew Dixon had no recorded disclosures.
View Andrew Dixon's current disclosuresAt the time the article was last revised Francis Deng had no recorded disclosures.
View Francis Deng's current disclosures- Hilus bifurcation sign
The hilum convergence sign is a useful chest radiograph sign to distinguish the cause of a bulky hilum as due to pulmonary artery dilatation or to a juxtahilar mass, including nodal enlargement.
If pulmonary vessels appear to converge centrally towards the lateral margin of the abnormal 'bump', then the hilar opacity is an enlarged pulmonary artery 1.
If vessels do not converge towards the opacity and instead converge more towards the waist of the heart, then the opacity is due to a hilar/mediastinal mass. The converging vessels can be traced through the opacity, indicating the related hilum overlay sign.
Terminology
Authors differ as to which of the aforementioned findings constitutes a 'positive' or 'negative' hilum convergence sign. Some write that the hilum convergence sign refers to the convergence of vessels onto the opacity, consistent with vascular dilatation, whereas vessels would not converge into a hilar mass 4-6. Others state the opposite: hilum convergence sign refers to vessels converging towards the waist of the heart, indicating a hilar mass 2. Others, following the original description, do not specify 1,3,7.
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History and etymology
Benjamin Felson (1913-1988) was an American radiologist who first described this sign, initially called the hilus bifurcation sign 3,7.
References
- 1. Parker MS, Chasen MH, Paul N. Radiologic signs in thoracic imaging: case-based review and self-assessment module. AJR Am J Roentgenol. 2009;192 (3): S34-48. doi:10.2214/AJR.07.7081 - Pubmed citation
- 2. George PP, Irodi A, Nidugala Keshava S et-al. 'Felson Signs' revisited. J Med Imaging Radiat Oncol. 2014;58 (1): 64-74. doi:10.1111/1754-9485.12031 - Pubmed citation
- 3. Felson B. The mediastinum. Seminars in Roentgenology. 1969:4(1);41-58. doi:10.1016/0037-198X(69)90016-9
- 4. W. Richard Webb, Charles B. Higgins. Thoracic Imaging. (2010) ISBN: 9781605479767
- 5. Melissa Rosado de Christenson, Santiago Martinez-Jiminez. Chest Imaging. (2019) ISBN: 9780199858064
- 6. Corral-Gudino L, Jorge-Sánchez RJ, Borao-Cengotita-Bengoa M, García-Aparicio J, Cascón-Bueno M. Exertional dyspnoea and abnormal chest radiography. (2009) BMJ (Clinical research ed.). 339: b2920. doi:10.1136/bmj.b2920 - Pubmed
- 7. Felson B. More Chest Roentgen Signs and How to Teach Them. (1968) Radiology. 90 (3): 429-41. doi:10.1148/90.3.429 - Pubmed
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