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Mitral stenosis

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

Elderly patient with a long history of cardiac disease.

Patient Data

Age: 80 years
Gender: Male
x-ray

Median sternotomy and MVR.

The subcarinal angle is splayed to 150 degrees ( usually less than 90 degrees).

Double right heart border from normal right atrium and enlarged left atrium.

Enlarged left atrial appendage.

Cardiomegaly, but no overt signs of cardiac failure.

Case Discussion

Mitral stenosis gives a number of classical chest radiograph appearances all shown in this film, although with evidence of subsequent mitral valve replacement.

Radiographic signs of a mitral heart are:

  1. cardiomegaly

  2. double right heart border - due to enlargement of the left atrium

  3. prominent left atrial appendage

  4. splaying of the subcarinal angle (150 degrees) - due to compression from the enlarged left atrium

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