Gross Right Atrial Enlargement

Cardiology X-ray Quiz 9

X-ray shows gross enlargement of the cardiac silhouette. Right heart border extends far to the right indicating gross right atrial enlargement. Presence of an associated pericardial effusion cannot be ruled out. Peripheral pulmonary vasculature is not so prominent indicating that the right atrial enlargement may be due to severe pulmonary hypertension and right ventricular failure. Organic tricuspid valve disease has to be considered as the cause for right atrial enlargement in this situation. Similar pattern can also occur in right ventricular inflow pathology like endomyocardial fibrosis in which restriction of right ventricular filling causes massive right atrial enlargement.