June 15, 2010

Left Atrial Enlargement

A frontal chest radiograph shows double density to the right of the spine (short arrows) and convex border of the left atrial appendage (long arrows).
A lateral view of the chest shows posterior displacement of the left mainstem bronchus by an enlarged left atrium (arrowheads).

Signs of Left Atrial Enlargement (LAE) on Chest Radiography
  • Convex left atrial appendage
  • Double density on the right side of the spine (one of the earliest signs)
  • Double density on the left side as the left atrium extends into the left lower lobe
  • Posterior displacement of the left mainstem bronchus posteriorly on lateral view, and superiorly on frontal view
  • Spreading of the carina
Common Causes of LAE
  • Acquired: mitral valve disease (stenosis or regurgitation), left ventricular failure, left atrial myxoma
  • Congenital: VSD, PDA, hypoplastic left heart complex
Our case: severe mitral regurgitation

Miller SW, Boxt LM, Abbara S. Cardiac Imaging the Requisites, 2009, 3rd edition.

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