Mitral stenosis

Case contributed by Aditya Shetty
Diagnosis almost certain

Presentation

Dyspnea and palpitations; diastolic murmur; past history of rheumatic fever.

Patient Data

Age: 40
Gender: Male
x-ray

X ray findings:

  • enlarged cardiac shadow
  • straightening of left heart border
  • double right heart border
  • splaying of carinal angle

Case Discussion

A case of mitral stenosis due to rheumatic heart disease:

  • normal area of mitral valve is 4-6 cm2
  • area less than 2 cm2 is considered stenotic
  • x-ray findings are noted at areas <1 cm2
  • left atrial enlargement causes double right heart border
  • straightened left heart border is formed by (from superior to inferior):
    • aortic knuckle
    • prominent left pulmonary conus (due to pulmonary hypertension)
    • concave left atrial appendage (normally convex)
    • left ventricle shadow

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