case presentation - lieberman's...
TRANSCRIPT
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.