Homogeneous Abnormal Hilar Shadow

CLINICAL DIAGNOSTIC MANUAL

A homogeneous abnormal hilar shadow on a chest X-ray refers to a uniform opacity in the area of the pulmonary hilum, which may indicate several pathological conditions.

The pulmonary hilum is the anatomical region where the bronchi, pulmonary arteries and veins, lymphatics, and nerves enter and exit the lung.

An abnormal hilar shadow can result from lymphadenopathies, vascular alterations, infections, or inflammatory diseases. A multidisciplinary approach is required to determine the underlying cause and provide appropriate treatment.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Metastatic lymphadenopathy	Dyspnoea, cough, weight loss, chest pain, haemoptysis	History of cancer in another organ, respiratory symptoms	Chest X-ray, chest CT, lymph node biopsy, PET scan
Lymphoma	Fever, night sweats, weight loss, lymphadenopathy, fatigue	History of persistent lymphadenopathy, systemic symptoms	Chest X-ray, chest CT, lymph node biopsy, specific blood tests
Primary tuberculosis	Persistent cough, fever, night sweats, weight loss	History of tuberculosis exposure, chronic symptoms	Chest X-ray, chest CT, tuberculin test, sputum culture
Prominent pulmonary artery	Dyspnoea, chest pain, fatigue, syncope	History of pulmonary hypertension symptoms	Chest X-ray, chest CT, pulmonary angiography, echocardiogram
Thickened pulmonary arteries due to pulmonary hypertension	Dyspnoea, fatigue, chest pain, peripheral oedema	History of chronic heart or lung disease	Chest X-ray, chest CT, echocardiogram, cardiac catheterisation
Sarcoidosis	Cough, dyspnoea, fatigue, weight loss, lymphadenopathy, erythema nodosum	History of systemic symptoms and lymphadenopathy	Chest X-ray, chest CT, tissue biopsy, angiotensin-converting enzyme (ACE) levels