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What does a prominent hilar shadow on chest x-ray mean?

Answered by: Irwin Ziment
Professor of Medicine
UCLA
USA

Q. I am a 21 year old male in sound physique. On casually taking a chest radiograph, they found a prominence of hilum on left side and my ESR is 5mm/1st hr, so they ruled out any TB. Can you explain the significance of the x-ray findings? Should I consult another doctor or should I do any more tests. 2 weeks back I had slight breathing difficulty with mild wheezing, my doctor gave an anti-histamine and a bronchodilator, breathing problem slowly reduced. My doctor told everything is fine. I am concerned about my ESR and the Xray finding. Please tell me its significance.

A.  A prominent hilar shadow on the chest x-ray of a 21 year old non-smoker suggests sarcoidosis, pulmonary hypertension or lymphoma. Other considerations include tuberculosis or a fungal infection, while lung cancer is an unlikely diagnosis. However, in some cases the isolated x-ray abnormality is not significant for any disease. To evaluate it further, a CT-scan and an electrocardiogram would be needed, and they may suggest the need for a bronchoscopy and a biopsy of any solid lesion. Sputum examination may not be reliable, and blood tests cannot provide a definitive diagnosis. Skin testing for tuberculosis would be significant if the test was positive, provided it was known to be negative previously.

A.  A prominent hilar shadow on the chest x-ray of a 21 year old non-smoker suggests sarcoidosis, pulmonary hypertension or lymphoma. Other considerations include tuberculosis or a fungal infection, while lung cancer is an unlikely diagnosis. However, in some cases the isolated x-ray abnormality is not significant for any disease. To evaluate it further, a CT-scan and an electrocardiogram would be needed, and they may suggest the need for a bronchoscopy and a biopsy of any solid lesion. Sputum examination may not be reliable, and blood tests cannot provide a definitive diagnosis. Skin testing for tuberculosis would be significant if the test was positive, provided it was known to be negative previously.

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