Chest X-Ray guide: how to assess the hilar regions

A female in her 50s presents with a few month history of a cough and has a chest X-Ray. What does it show?

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LUNG CANCER AND ENLARGED HILAR NODES
👨🏽‍💻The key to this case is assessing the hilar regions in detail

👨🏽‍💻The density of the right hilum is abnormal when compared with the left whilst the morphology also does not resemble branching tapering vessels as you would expect

👨🏽‍💻The second abnormality is an extra contour next to the right hilum. Given this is separate to the hilum this must lie anterior or posterior to the hilum

👨🏽‍💻Infective consolidation with enlarged nodes is possible but given the lesion is very well defined lung cancer with enlarged nodes at the hilum must be considered

👨🏽‍💻This was confirmed on CT, PET-CT and CT biopsy

👨🏽‍💻The key here is to be able to piece apart the hilar regions - remember to assess the density and morphology and look for anything overlying them

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[oppai.lord.__]

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[rwagonyacaleb]

You're making me love radiology, thanks for sharing..

[valeriegreco]

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[EldritchS]

Thank you very much for sharing this

I alwyas looked for such content
Keep it up

[midog]

Thanks.
That was a fabulous xplanation

[jamesfearn]

Love your work. Interesting you mention lateral views. From my time in ED I know radiographers will often do additional views when there is bony pathology for extremities on their own initiative. Wonder why there is hesitancy in the case of chests ? Perhaps the protocols/pathways have ct high res/chest abdo pelvis as default pretty much everywhere?

[joan]

El diafragma esta aplanado y las cosillas están horizontalizadas también

[acetpang]

My understanding was that adenocarcinoma was poorly avid on PET?

[simonmasenda]

What are those shadows in the lower lung fields