Left Atrial Enlargement

Table of Contents

Table of Contents

Lauren Brown, MD
Expert review – pending

Objectives

  1. Use tracheal and mediastinal deviation to help differentiate the etiology of lung whiteout (opacification of hemithorax) and other large opacities.

Teaching Instructions

Plan to spend 5-10 minutes familiarizing yourself with the animations of the PowerPoint and the key findings of this chest X-ray.

Present the image either by expanding the window (bottom right) in a browser or downloading the PowerPoint file (downloading is recommended for best function).  Have the image pulled up in presenter mode before learners look at the screen to avoid revealing the diagnosis.  Ask a learner to provide an overall interpretation.  Then advance through the animations to prompt learners with key questions and reveal the findings, diagnosis, and teaching points.

Instructions: Ask a learner to provide an overall interpretation.  Advance the slide for subsequent questions.

CXR Read: Enlarged cardiac silhouette with prominent left atrial and right atrial chambers.

Diagnosis: TTE revealed severe mitral stenosis with moderate mitral regurgitation and massive left atrium, right ventricular hypertrophy, and enlarged right atrium.  Clinical diagnosis of rheumatic heart disease.

Teaching:

  1. Beware, not all enlarged cardiac silhouettes are due to cardiomegaly.
  2. Left atrial enlargement is best identified by TTE but can be seen directly in extreme cases by the deviation of the trachea or a “double density sign”, as we see in this case.
  3. In the absence of LVH, LAE is often an indication of mitral valve disease.

Presentation Board

Take Home Point

  1. Left atrial enlargement is best identified by TTE but can be seen directly in extreme cases by the deviation of the trachea or a “double density sign”, as we see in this case.
  2. In the absence of LVH, LAE is often an indication of mitral valve disease.

References

Higgins CB, Reinke RT, Jones NE et-al. Left atrial dimension on the frontal thoracic radiograph: a method for assessing left atrial enlargement. AJR Am J Roentgenol. 1978;130 (2): 251-5.

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