Mitral valve regurgitation

Case contributed by Mark Holland
Diagnosis certain


Previous childhood rheumatic fever

Patient Data

Age: 60 years
Gender: Female

Chest x-ray demonstrates cardiomegaly with features of left atrial enlargement (double contour on the right, splayed carina and enlarged left atrial auricle). The heart is also generally enlarged as are the pulmonary veins, particularly in the right upper zone. 

Annotated image

Annotated image

The rough outline of the left atrium (yellow) can be inferred by the presence of a double border on the right (green arrow), splaying of the carina (blue) and prominence of the left atrial appendage (red arrow). 

Case Discussion

This case demonstrates typical radiographic features of chronic mitral regurgitation (confirmed on echocardiography) including:

  • convexity or straightening of the left atrial appendage along the left heart border below the main pulmonary artery due to left atrial enlargement;
  • double density projecting over the right heart, reflecting superimposition of enlarged left atrium over the right heart
  • elevation of the left main bronchus and splaying of the carina by enlarged left atrium
  • left ventricular enlargement
  • cephalization of flow due to pulmonary venous hypertension

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