CTICasesGiant Left Atrium Secondary to Rheumatic Heart Disease
Imaging findings
Chest CT demonstrates massive, aneurysmal dilatation of the left atrium, which is large enough to form the left heart border on radiographs and severely compresses the adjacent lower lobe bronchi, causing extensive mosaic attenuation and air trapping. The left atrial appendage is particularly prominent. Slow, stagnant blood flow within the giant left atrium is visualized as heterogeneous contrast mixing and "white smoke" streaming from the pulmonary veins.
Key takeaways
Rheumatic heart disease can lead to extreme, giant left atrial enlargement as a chronic sequela of severe mitral valve stenosis or regurgitation. The massive dilatation of the atrium can cause mechanical mass effect on surrounding structures, leading to compression of the mainstem and lower lobe bronchi, progressive atelectasis, and air trapping. Additionally, the stagnant flow within the giant cavity predisposes patients to a high risk of intra-atrial thrombus formation and thromboembolic events, which are visible as swirling flow artifacts on contrast-enhanced CT.
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