X-ray chest PA view showing prominent upper lobe vessels in a case of mitral stenosis. As pulmonary venous hypertension progresses, there is redistribution of pulmonary blood flow from lower lobes to upper lobes. This is also known as cephalization. The other names given for this sign are ‘Antler sign’ and ‘upturned moustache sign’.
In this X-ray, right cardiac border is shifted to the right, indicating right atrial enlargement. Right atrial enlargement in mitral stenosis occurs secondary to pulmonary hypertension and right ventricular hypertrophy. A faint shadow within shadow inside the right cardiac border is also visible, indicating left atrial enlargement which is usually more marked than right atrial enlargement in mitral stenosis. A well formed shadow within shadow is also called as double atrial contour. Other signs to be looked for in mitral stenosis on chest X-ray are elevation of left bronchus due to left atrial enlargement, prominent main pulmonary artery and branch pulmonary arteries due to pulmonary hypertension, prominent left atrial appendage and straightening of the left border. Kerley B lines may be seen near the costophrenic angle as small horizontal lines due to thickened interlobular septa. An X-ray image of Kerley B lines is also available. A description on Kerley A lines and Kerley C lines are also available on that page. You can also have a look at another chest X-ray in mitral stenosis.