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Atrial escape

Atrial escape refers to a chest x-ray sign of massive left atrial enlargement and is an exaggerated version of the double density sign.  

Normal the right border of the left atrium is not visible. As it enlarges it forms a distinct border projecting through the right heart shadow, medial to the right heart border (see normal cardiomediastinal outline). When the atrium enlarges further, eventually its right border projects lateral to the normal right heart border. It is this reversal of the usual double density sign which is known as atrial escape. 

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