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Hilar structures
Key points
Each hilum contains major bronchi and pulmonary vessels
There are also lymph nodes on each side (not visible unless abnormal)
The left hilum is often higher than the right
If a hilum is out of position, ask yourself if has been pushed or pulled
As well as position - check the size and density of the hila
The hila (lung roots) are complicated structures mainly consisting of the major
bronchi and the pulmonary veins and arteries. These structures pass through the
narrow hila on each side and then branch as they widen out into the lungs. The hila
are not symmetrical but contain the same basic structures on each side.
Although the hilar lymph nodes are not visible on a normal chest X-ray, they are of
particular clinical importance. Often, hilar enlargement is due to enlargement of
these nodes.
Many disease processes involve the hila, and so a good knowledge of their normal
X-ray appearance is important. There is, however, a wide range of normal. The hila
may be at the same level, but commonly the left hilum is higher than the right. Both
hila should be of similar size and density. If either hilum is bigger and more dense,
this is a good indication that there is an abnormality.
Pulmonary arteries
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Pulmonary arteries
Deoxygenated blood (blue arrows) is pumped upwards out of the right ventricle
(RV) via the main pulmonary artery (MPA)
The MPA divides into left (LPA) and right (RPA) which each pass via the lung hila
into the lung tissue to distribute blood for oxygenation
On the left the LPA hooks backwards over the left main bronchus
On the right the RPA lies in front of the right main bronchus
Normal hilar position
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