Image Case-Cardiac (Mitral Valve Disease)

CXR in Mitral Stenosis: The left atrial appendage is the only portion of the left atrium that forms part of the left border of the heart. On PA radiographs it occupies the portion of the left heart border between the main pulmonary artery segment and the superior portion of the left ventricular contour. When left atrial pressure and volume are normal, this segment of the left heart border is concave. Early or mild enlargement of the left atrium may be detected as enlargement of the left atrial appendage with straightening of this segment of the left heart border. With continued enlargement, this segment will become convex. Another finding of left atrial enlargement include a "double density" in the mid-portion of the cardiac silhouette on the frontal view. Other findings which can suggest LA enlargement include posterior esophageal displacement on barium swallow, elevation of the left mainstem bronchus, and straightening of the left heart border due to enlargement of the left atrial appendage. In cases of long-standing stenosis, the LA wall may calcify. Mitral valve calcification is only seen 10% of cases. Pulmonary venous congestion can be seen as the stenosis progresses. Since the left ventricle is unaffected by mitral stenosis it will remain normal. Later there is pulmonary arterial hypertension and right ventricular enlargement.