Left atrial enlargement

Case contributed by Alexandra Stanislavsky
Diagnosis certain


Shortness of breath and poor exercise tolerance.

Patient Data

Age: 75 years
Gender: Female

This patient has had a sternotomy and a prosthetic mitral valve. There is splaying of the carina with elevation of the left main bronchus, a double right heart border and cardiomegaly.  The features are those of left atrial enlargement.

Pulmonary vasculature is prominent particularly in the upper zones. 

Annotated image

Although the entire heart is enlarged, a double contour is seen through the right side of the heart. The more medial line is the enlarged left atrium (white dotted line) and the heart border is more lateral (blue dotted line). 

The size of the left atrium (blue arrow)  measured from the mid point of the left main bronchus (yellow dotted line) to the mid point of the double density line (white dotted line) is clearly more than 7cm. 

The subcarinal angle (yellow solid line) is also enlarged, much more than the upper limit of normal taken to be 90-100 degrees. 

Case Discussion

Typical x-ray features of left atrial enlargement seen in a patient with a history of mitral valve disease, which is indicated by the mitral valve prosthesis.

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