Hilar mass: the value of interval imaging

Case contributed by Dr Ian Bickle


Lifelong smoker. A chronic cough and shortness of breath. COPD exacerbation?

Patient Data

Age: 70 years
Gender: Male


Ill-defined approximately 2.5cm opacity in the lower right paratracheal space.

2cm opacity at the right hilum causing in-filling of the right hilar angle.

The background lungs are emphysematous.

** note this common problem in COPD patients of getting the whole thorax on a single radiograph



The lungs are hyperinflated with emphysematous changes in both upper lobes.

Heart size normal.

Normal appearances of both hila.

5cm irregular mass in the anterior segment of the right upper lobe.

Enlarged bulky right pre-carinal and right hilar lymphadenopathy. 

The lungs are emphysematous.

Radiological stage:  T2a,N2,Mx.

Annotated image

Annotations to show 2016 and 2017 appearances of the hila

The normal 2016 radiograph there are 2 normal hilar angles with no in-filling of this space.

On the 2017 radiograph, the right hilar angle is filled in by a lymph node mass (straight arrow). 

An additional mass has arisen in the lower right paratracheal space (curved arrow).

Case Discussion

This is an interesting learning case on several levels with some important radiological life lessons.

1.   With COPD patients often the whole patient cannot be imaged on one radiograph.   When one has to piece up the 2 pieces this can be more challenging to interpret.

2.  The most useful thing for any radiologist is old imaging studies.    Not looking for them or at them at your peril.

3.  Satisfaction of search - don't be happy with spotting one abnormality.  Look for more it may take you further down the diagnostic pathway.

This was a histologically proven lung cancer.

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Case information

rID: 56830
Published: 13th Jan 2018
Last edited: 14th Aug 2019
System: Chest
Tag: rdgh
Inclusion in quiz mode: Included

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