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

Left Atrial Enlargement

Anatomy

• Left Atrium, Appendage.

• Anterior: Ventricles, Mitral Valve

• Superior : Left Bronchus, Carina

• Posterior Descending Aorta, Esophagus, Thoracic Duct

• Inferior : Coronary sinus

Normal Chest plain film

Images courtesy of Dr. Sven Paulin

Normal Chest plain film

Images courtesy of Dr. Sven Paulin

Normal Chest plain film

Normal Chest plain film

How does this look on CT?

How does this look on CT?

T7-T8 level

How does this look on CT?How does this look on CT?

T7-T8 level Left Appendage

Left Atrium

How does this look on CT?How does this look on CT?

T7-T8 level Left Appendage

Left Atrium

How does this look on CT?

How does this look on CT?

How does this look on CT?

Left Atrium

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

Double Contour

Double Contour

Left Hilus Elevation

Double Contour

Left Hilus Elevation

Horizontal course of the left Bronchus

Double Contour

Left Hilus Elevation

Horizontal course of the left Bronchus

Left Apendage enlargment

Left Bronchus Posterior Deviation

Left Bronchus Posterior Deviation

Descending Aorta posterior

deviation

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

Aknowledgements

• Dr. Sven Paulin

• Dr. Diana Litmanovich

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.