Dyspnoea in a 60 year old manBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3404 (Published 07 July 2010) Cite this as: BMJ 2010;341:c3404
- Yuri K Gupta, specialist registrar in radiology,
- Asif A Mazumder, specialist registrar in radiology,
- David V Hughes, consultant radiologist,
- David C Howlett, consultant radiologist
- 1Eastbourne District General Hospital, King’s Drive, Eastbourne, East Sussex BN21 2UD
- Correspondence to: Y Gupta
A previously well 60 year old man was referred by his general practitioner with a six week progressive history of exertional shortness of breath, without cough, wheeze, or pain. He was a non-smoker. On auscultation his chest was clear. His oxygen saturation was 98% on air, with a respiratory rate of 15 breaths/min. He was afebrile, with a pulse rate of 78 beats/min and blood pressure of 160/95 mm Hg. Physical examination showed enlarged bilateral neck nodes in the anterior cervical chain. Chest radiography was performed (fig 1⇓).
1 What are the radiographic findings?
2 What is the differential diagnosis?
3 What further investigations should be arranged?
1 What are the radiographic findings
The radiograph shows symmetrical lobular enlargement of both pulmonary hila, with no signs of cardiomegaly or vascular abnormality (fig 2⇓). This appearance is consistent with bilateral hilar lymphadenopathy.
Bilateral hilar lymphadenopathy can be defined as evidence of bilateral enlargement of the hilar nodes, commonly discovered on a chest radiograph.1 It can manifest on chest radiography as abnormal hilar density, size, or shape. Hilar adenopathy appears as round or lobulated abnormal soft tissue arising from the hila. Lack …