Radiological appearance of mitral stenosis

Possible features include:

• cardiothoracic ratio:
  • the heart size is normal (small left ventricle)
    
    
• in the presence of pulmonary hypertension there will be right ventricular hypertrophy and tricuspid regurgitation, a dilated right atrium and pulmonary artery
  
  
• dilated left atrium - the carina will be splayed
  
  
• pulmonary vessels:
  • increased flow through upper lobes as pulmonary vascular changes begin in the lower lobes
  • hydrostatic pressure increases pulmonary venous pressure in lower lobes
  • the pulmonary artery and branches dilate with pulmonary hypertension
    
    
• Kerley's lines:
  • are caused by interlobular oedema and dilated lymphatics
  • they appear as horizontal line shadows at the costophrenic angles
  • Kerley's lines indicates a high left atrial, and pulmonary venous, pressure
    
    
• in long standing and severe mitral stenosis there may be calcification of the mitral valve