Lateral Chest Radiograph

In order to evaluate the hila in the lateral view, the normal anatomy must be known.

Five normal hilar structures are usually visible.

• The lucent, round left upper lobe bronchus seen on end (LUL)
• The linear posterior wall of the right bronchus intermedius (BI)
• The arch-like or wedge shaped left pulmonary artery (LPA)
• The oval right pulmonary artery (RPA)
• A small superior pulmonary vein seen on end below the hila (PV)

LABELED LATERAL VIEW OF NORMAL HILUS	UNLABELED NORMAL HILUS
Five labeled normal structures.	Normal structures in another patient.

The small oval pulmonary vein is the only normal round density inferior to the hila. If there a large infrahilar increased density, this is lymphadenopathy or a lung mass. If there is a "doughnut" of increase density surrounding the "hole" which is the end on left upper lobe bronchus, this indicates more advanced hilar lymphadenopathy.

The lateral radiographs of the next three patients show hilar lymphadenopathy of differing magnitude.

LATERAL VIEWS	OF HILAR	LYMPHADENOPATHY
This patient has hilar lymphadenopathy seen as a "donut" of soft tissue density surrounding the "doughnut hole" which is the end on left upper lobe bronchus (arrow).	A lopsided soft tissue "doughnut" surrounds the end on LUL bronchus (arrow). This is more advanced hilar lymphadenopathy. (The opaque line is a nasogastric tube.)	Here there is an area of infrahilar soft tissue density that is much too large to be a normal pulmonary vein. This is less advanced hilar lymphadenopathy.(LUL=left upper lobe bronchus)

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