Left atrial enlargement on chest radiography (illustration)

Case contributed by Vincent Tatco
Diagnosis not applicable

The following are the radiologic signs of left atrial enlargement on frontal chest radiographs:

  • double density sign
  • distance of the right border of the left atrium from the midpoint of the left mainstem bronchus is more than 7 cm
  • enlarged left atrial appendage (third mogul sign)
  • uplifted left mainstem bronchus
  • widening of the carinal angle (more than 90 degrees)
  • atrial escape (the right border of the markedly enlarged left atrium goes beyond the right atrial margin)

On lateral chest radiographs, an enlarged left atrium results to:

  • prominence of the upper posterior cardiac convexity
  • posterior displacement of the left mainstem bronchus (walking man sign)

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