CTICasesMassive Pulmonary Embolism Mimicking Hilar Adenopathy
Imaging findings
An anteroposterior chest radiograph of a 29-year-old patient presenting after a syncopal episode shows apparent prominence of the bilateral hilum, which was initially misinterpreted as hilar adenopathy. Subsequent contrast-enhanced CT of the chest reveals massive, saddle and bilateral main pulmonary artery thromboemboli, with marked enlargement of the main pulmonary trunk, without classic radiographic signs of pulmonary oligemia (Westermark sign) or pleural-based consolidation (Hampton's hump).
Key takeaways
Massive pulmonary embolism (PE) can manifest on chest radiographs as enlargement of the main and lobar pulmonary arteries, which can easily be misdiagnosed as hilar adenopathy, particularly on portable or AP-only views. Clinicians and radiologists must maintain a high index of suspicion for PE in young patients presenting with acute chest tightness, syncope, or unexplained cardiovascular collapse.
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