The hila are normal anatomic areas in both lungs that are seen in the center of a chest X-ray. They are the site of the origin of the large blood vessels that carry blood to the lungs (pulmonary arteries), the large bronchial tubes that emerge from the root of the lungs, and adjacent lymph nodes. Hilar enlargement can be seen, with an increase in size of any of these structures. “Prominence” means that one or more components of the hilae are enlarged. Sometimes it is possible to conclude which structure is involved, based on location and appearance within the hilum, but often this is not possible; hence the use of the term, “hila shadows”. Sometimes the X-ray appearance is so characteristic that a skilled radiologist can suggest a diagnosis with reasonable certainty.
Usually, however, before venturing an educated guess in this latter circumstance, it is usually necessary to obtain more detailed views of the hila with a CT Scan of the chest.
Your first step should be to ask your physician if, on the basis of the X-ray, he/she can indicate the most likely diagnosis or if not, what the next diagnostic study should be.
To answer your question regarding the possibility of a neoplasm, in a smoker, the answer is yes, this would be one possibility but the likelihood of lung cancer is much reduced by the fact that the prominence is bilateral.
In any event, this finding cannot be ignored unless the radiologist registers a very high suspicion that the shadows represent a normal variant or are highly reflective of a benign diagnosis such as Sarcoidosis. Unless this is the response, further testing must be done.
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