X-Ray quiz – Cardiology MCQ – Answer

This X-ray chest PA view is suggestive of:
Correct answer: c) Biatrial enlargement with pulmonary venous hypertension 

Prominent upper lobe vessels are suggestive of pulmonary venous hypertension. Eponyms for this finding include: antler sign, inverted mustache sign, redistribution and cephalisation. Normally lower zone vessels are more prominent than upper zone vessels due to the effect of gravity. Left bronchus is elevated due to left atrial enlargement. Prominent left atrial appendage is also known as ‘third mogul sign’; first mogul being aortic knuckle and second mogul pulmonary artery segment. Descending aortic contour seen to the left of the spine within the cardiac shadow. Right bronchus is more vertical than the left which is almost horizontal. There is widening of carinal angle, another radiological sign of left atrial enlargement. Left atrial border is seen as a semilunar shadow within the right atrial contour (shadow within shadow, double atrial contour), indicating left atrial enlargement. Right atrial border noted well away from the spine, indicating significant right atrial enlargement. Together these findings are likely to occur in severe mitral stenosis with pulmonary venous and arterial hypertension.
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