This patient had rheumatic heart disease with mitral stenosis. Left atrial enlargement is suggested by the “double contour” sign, (i.e. 2 right heart borders), and the “ballerina” sign, an increase in the angle between the left and right main bronchi (also known as a “splayed carina”). Other signs of left atrial enlargement (not well seen here) include a straightening of the left heart border and elevation of the left main bronchus (specifically the upper lobe bronchus on the left lateral film), with a distance between this bronchus and the “double” heart border >7 cm. There is also cardiomegaly (cardiothoracic ratio >0.5), suggesting ventricular failure. Loss of angle between left pulmonary artery and left heart border also suggests ventricular enlargement. Prominent vasculature in bilateral lung fields, with cephalization (more prominent towards the upper fields), suggests pulmonary venous congestion, interstitial edema, and pulmonary hypertension. Mitral valve calcification is difficult to appreciate and better seen with fluoroscopy.
