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11 yr old has chest pain, x-ray shows bilateral hilar prominence. What is wrong ?

Hi. My son is 11 years old he had chect pains. the X-ray done showed a normal cardiomediastinal silhouette, clear lung fields, no pleural effusions noted, the body thorax and soft tissues are normal, but there was Bilateral hilar prominence that could be vascular or due to lymphadenopathy . Please would you kindly tell me what is wrong with my son? AAAAA
Asked On : Fri, 2 Nov 2012
Answers:  2 Views:  688
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General & Family Physician 's  Response
Hello mhlongot ,

greetings from

I am Dr Sourav Chakraborty and will be helping you with your query

As i see , you have provided only the chest X ray report along with a single symptom of chest pain , you have not revealed the duration of chest pain , any episodes of fever and if so since when , any cough with sputum production . These are important points to look into so as to come to a significant conclusion . I also assume you have done a baseline ECG and an Echocardiogram for your son and such are in normal limits , if not then plaese do get it done. Bilateral hilar prominence are mostly seen in frequent or recurrent respiratory tract infections, sarcoidosis , extrinsic allergic alveolitis ,lymphoma, carcinoma , tuberculosis, mycoplasma ,organic dust disease like silicosis histocytosis x and vascular causes. His clinical examination is very important to narrow down to a significant conclusion which i lack completely for your son and interpretation is currently on very limited information provided by you . Respiratory tract infection do present with chest pain while breathing but it is completely curable with proper antibiotic prophylaxis and rest. Please do take your son to a primary physician and get him evaluated . You can get a chest X ray repeated around 2-3 months after your son gets treated by his doctor , chances are it might show no such hilar prominences . Do not panic and take care.
Answered: Fri, 2 Nov 2012
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General & Family Physician Dr. Debraj Jash's  Response
There are many causes of bilateral hilar lymphadenopathy in 11 years old boy. You did not mention whether your son has history of frequent fever, cough and cold , swelling anywhere in the body( peripheral lymphadenopathy) . At this age, this could be most commonly due to infective cause( tuberculosis, histoplasmosis, infectious mononucleosois). Possibility of sarcoidosis, lymphoma also has to be kept in mind. Sarcoidosis and tuberculosis both may present with isolated hilar lymphadenpathy withot any pulmonary involvement. You should perform contrast enhanced CT thorax . Presence of necrotising lymph node willgo in favour of tuberculosis or histoplasmosis. I do not know in which country you reside. In countries like India, it could be due to T.B whereas in countries like U.S.A this could be due to histoplasmosis. Also mantoux had to be performed as negative mantoux will favour diagnosis of sarcoidosis. Also perform routine haemogram, Serum angiotensin converting enzyme(SACE) , urinary calcium. If your son's C.T shows subcarinal lymph nodes, then transbronchial needle aspiration along with bronchial mucosal biopsy may be done to confirm sarcoidosis or lymphoma. Don't get frightened. But I must answer all the possibilities to you. Both tuberculosis, sarcoidosis, histoplasmosis had excellent prognosis. Don't neglect your child's health.
Hope, I satisfied your queries All the best for your child's future.
Answered: Fri, 2 Nov 2012
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