CASE PRESENTATION Left Atrium on Plain Chest Films Nicolás Ahumada Pavez 7th year Pontificia Universidad Católica de Chile School of Medicine Dr. Gillian Lieberman
CASE PRESENTATIONLeft Atrium on Plain Chest Films
Nicolás Ahumada Pavez7th year Pontificia Universidad Católica de Chile
School of Medicine
Dr. Gillian Lieberman
• 52 years old female
• Many respiratory infections in early childhood
• History : 2 days of cough, mild fever
• Physical exam is unremarkable
• Physician wants to rule out Pneumonia
Anatomy
• Left Atrium, Appendage.
• Anterior: Ventricles, Mitral Valve
• Superior : Left Bronchus, Carina
• Posterior Descending Aorta, Esophagus, Thoracic Duct
• Inferior : Coronary sinus
Left Atrial Enlargment signs on plain film
• Double Contour
• Left Hilium elevation
• L. Appendage enlargment
• Horizontal course of the Left Bronchus
• Descending Aorta posterior deviation (On lateral plain film)
• Left Bronchus posterior deviation. (On lateral plain film)Image from: J. Willus Hurst, Memories of patients with a Giant Left Atrium, Circulation
LEFT ATRIAL ENLARGEMENT DDX
• Mitral valve disease
• prolapse, ischemia, rheumatic heart disease, endocarditis, annular calcifications
• Left ventricular failure, of any cause.
• Atrial Myxoma.
Braunwald´s Heart Disease, 7th edition
Kothari AA, Kothari KA. A giant left atrium. J Postgrad Med 2005;51:49-50
Dysphagia and Left Atrial Enlargement
Mehmet, et al. Giant Left Atrium with Rheumatic Mitral Stenosis. Tex Heart Inst J. 2006
World´s largest published Left Atrium. 19.6cm2
References
• Brauwald´s Heart Disease, 7th edition, Elsevier International.
• Mehmet, et al. Giant Left Atrium with Rheumatic Mitral Stenosis. Tex Heart Inst J. 2006
• Kothari AA, Kothari KA. A giant left atrium. J Postgrad Med 2005;51:49-50
• Hurst JW. Memories of patients with a giant left atrium. Circulation. 2001;104:2630 –2631.