chest x-ray - why would cardiologist think it might be "pulmonary arterial hypertension"

[Mt. Carmel]

My cardiologist/internist recently ordered a chest x-ray due to a cough I've had for 2 months.  After the radiologist's report, he wanted previous chest x-rays and an echocardiogram.  I asked why all this for a cough. Apparently the radiologist saw something on the x-ray that suggested "pulmonary arterial hypertension".  Well, I looked that up... and it ain't a pretty picture (pun intended).

When I reminded him that he did an echocardiogram 18 months earlier and it was normal, he decided I didn't need another one.

The radiologist's original report: "The heart is within normal limits for size. The hila are bilaterally prominent which may reflect vasculature. Correlation with prior chest radiograph, if available, would be helpful. There is no confluent infiltrate or pleural effusion. There is no mediastinal lymphadenopathy."

After viewing a 2 year previous x-ray the radiologist wrote: "The prominent hilar structures, consistent with vascular structures appear unchanged.  Heart, mediastinum and bony structures are also stable."

I've researched basic terminology, but could you explain why they would think pulmonary arterial hypertension in the first place? I'm guessing it has to do with "prominent hila...reflect vasculature", but can't quite get it. Any insight would be appreciated.

Cheers -
Mt. Carmel

[National Jewish]

Your conclusion is correct.  It is due to the prominence of vessels in the hila that the radiologist has suggested PHT.  However, this is a clinical diagnosis, as well.  Your pulmonologist is the best one with which to have this discussion.

[Mt. Carmel]

Thank you for your comments.  I had already set an appointment with a pulmonogist for a second opinion.

If you have a moment more, I'm curious... you wrote "However, this is a clinical diagnosis".  What other kinds of diagnoses are there?

Thanks again.

[npne]

I have been diagnosed with two leaky heart valves and also primary pilmonary hypertension. I alo have a gastric band in place. I believ band to be a little tight, which will be resolved in about a week. However I do havine coughing spells at noc. at times  These coughing spells will triger what I believe to be a vaso-vago respons, as I can't seem to get my breathf [ am on o2 at noc at times also]. My whole body will get very cold and fingers will at times go numb.  After about 3-4 hours of this I will then get very warm.  What seems to be going on. God will not let me see the white light and let me out of my misery.It gets a little scary at times.