How to differentiate Hilar mass from Hilar vessel ?

It may be difficult to identify...

Sometimes it may be difficult to identify a large vessel from an enlarged hilar lymph node. See for example-. In such a case, you can discriminate the two by the following-

  • If the perihilar vessels converge towards the lesion, or to approximately 1 cm medial to the lesion, then the lesion is a hilar vessel, and not an enlarged lymph node or mass.
  • If the perihilar vessels don’t converge towards the lesion but are converging away from the lesion, then the opacity is a hilar lymph node or mass.

In this case, the right hilum appears prominent. But the hilar vessels appear to converge towards the pulmonary hilar prominence. Hence the prominent hilum is actually an enlarged right descending pulmonary artery. Also, note the prominent pulmonary conus. This is a case of Pulmonary arterial hypertension.

Case courtesy of Dr Maulik S Patel, Radiopaedia.org, rID: 19364

Note that in this mass, which is located in the left hilum, the hilar vessels don’t converse towards the mass, but are seen through the mass. This is a left hilar bronchogenic carcinoma.

Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 50353

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