Digestive Disorders / Gastroenterology Expert Forum
Right Hilar Fullness
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Right Hilar Fullness


  I am posting this for my mom who does not have computer access.  She is a 65 yr old woman.  A few weeks ago she was acutely ill with high ffever, chest pain, vomiting, difficulty swallowing, and upper respiratory symptoms, fever up to 103-104.  Bacterial infection in bloodstream was diagnosed and treated with IV and oral antibiotics.  During testing chest xray was done and came back abnormal, large "mass" found in right esophagus.  That is how it was explained to her.  They wanted to wait until infection cleared and redo xray to see if possibly it was the infection causing the abnormal xray.  Chest xray was redone and doc gave her copy of results in the office.  This is a synopsis of the radiologoy report:
  "Nodularity is diminished in the right hilar region but this may be due to differential technique....May be related to vascular congestion which is minimally improved since previous study, but would suggest continued follow up with chest x-ray in approximately 3 months time to rule out an enlarging density.  Alternatively, can do CT but would certainly recommend comparison to old films if possible to further evaluate.  There is incidental note made of calcified rib ends bilaterally."
  As far as we can determine, there are no previous xrays to compare with.  Her GP does not feel comfortable waiting for further testing, and has ordered a CT scan to be done next week.
  What are different types of things this could represent?  My mother is terrified this may be cancer....however to me it seems if they thought it was cancer the report would have indicated more urgent testing.  Are there other conditions that could cause this, and what exactly does "right hilar fullness" mean?  What does "vascular congestion" mean?  There is a family history of connective tissue disease....I have UCTD and Sjogrens, my daughter, her granddaughter developed Graves disease at age 8 and SLE at age 12, my mom has had arthritis symptoms but when I suggested she ask her doctor about ANA testing her doctor said it was a waste of time and her arthritis was simply "inflammatory arthritis" and there was absolutely no reason to order an ANA despite the history in the family....is there any way this problem could relate to a possibly CTD?  Also, what does "calcified rib ends bilaterally" mean?
  The diagnosis codes on the bill listed:  1) precordial pain, 2)hypertension, and 3)abnormal chest xray.  Also, my mother does have a history of hypothyroidism and hiatal hernia.  Thank you very much for your response.  My mother is begging for information.  I really appreciate this forum being provided for us cyberfolks!
  Ellen
Dear Ellen,
Most patients with esophageal cancer present with difficult swallowing, poor appetite,weight loss or black stools (indicating bleeding). Some patients with esophageal cancer present with pulmonary symptoms secondary to an abnormal connection between the esohagus and trachea called a tracheo-esophageal fistula. An easy way to confirm or exclude esophageal cancer is to perform an esophagram and/or an upper GI endoscopy. Right hilar fullness and vascular congestion are findings on a chest x-ray. Right hilar fullness refers to a fullness in the shadow in the right center side of the chest. There are a number of causes for this finding including but not limited to congestive heart failure, sarcoidosis, pneumonia and lung cancer. Vascular congestion refers to engorged vessels secondary to backup of fluid (into the lungs)from the heart as occurs in patients with congestive heart failure who cannot effectively pump blood out of the heart to the rest of the body. A CT scan of the chest will certainly provide more information as to the nature of these x-ray findings and help direct further work-up as necessary. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
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