Radiological appearance of aortic stenosis

Features that may indicate aortic stenosis include:

• calcified aortic valve - on a lateral chest X-ray the calcified valve is seen above an imaginary line joining the costophrenic angle and the lung hilum. On the posteroanterior view the calcified valve may not be seen because of the overlap of the spine and mediastinal structures. A calcified aortic valve is easily discriminated from a calcified mitral valve on a lateral film because the mitral valve lies below an imaginary line joining the lung hilum and anterior costophrenic angle.
• heart size is normal
• the PA chest film may show features suggestive of left ventricular hypertrophy.
• post stenotic dilatation leading to a prominence of the ascending aorta.
• if there is decompensation then there are also features of pulmonary venous hypertension.