You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Also, tell your doctor if you plan to have any x-ray procedure in which dye is injected, especially if you drink or have ever drunk large amounts of alcohol or have or have had liver disease or heart failure. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. You may have to stop taking metformin until you recover. Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection severe diarrhea, vomiting, or fever or if you drink much less fluid than usual for any reason. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Taking certain other medications with metformin may increase the risk of lactic acidosis. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack stroke diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment) a coma or heart or liver disease. Your doctor will probably tell you not to take metformin. Tell your doctor if you have kidney disease.
Others, following the original description, do not specify 1,3,7. Others state the opposite: hilum convergence sign refers to vessels converging towards the waist of the heart, indicating a hilar mass 2. Some write that the hilum convergence sign refers to the convergence of vessels onto the opacity, consistent with vascular dilatation, whereas vessels would not converge into a hilar mass 4-6. TerminologyĪuthors differ as to which of the aforementioned findings constitutes a 'positive' or 'negative' hilum convergence sign. The converging vessels can be traced through the opacity, indicating the related hilum overlay sign.
If vessels do not converge towards the opacity and instead converge more towards the waist of the heart, then the opacity is due to a hilar/mediastinal mass. If pulmonary vessels appear to converge centrally towards the lateral margin of the abnormal 'bump', then the hilar opacity is an enlarged pulmonary artery 1. The hilum convergence sign is a useful chest radiograph sign to distinguish the cause of a bulky hilum as due to pulmonary artery dilatation or to a juxtahilar mass, including nodal enlargement.
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