title: Chest radiographs are unreliable in predicting thrombi in the left atrium or its appendage in rheumatic mitral stenosis.
abstract: We have assessed the diagnostic accuracy of a flat or concave left mid-cardiac border (the region of the left atrial appendage) on conventional postero-anterior chest radiographs as a predictor of the presence of thrombi in the left atrium or its appendage in 80 patients with rheumatic mitral stenosis who subsequently underwent open-heart surgery. Forty-six patients (Group I) were found to have left atrial thrombus at surgery whereas 34 patients (Group II) showed no evidence of thrombosis. Only 22 of 46 patients in Group I showed a flat or concave left mid-cardiac border (sensitivity, 48%; specificity, 53%; positive predictive value, 58%). Furthermore in Group 1, the thrombus involved the left atrial appendage in 33 patients. In this subgroup only 14 patients showed a flat or concave left mid-cardiac border (sensitivity, 42%; specificity, 49%; positive predictive value, 37%). The presence of flatness or concavity in the left mid-cardiac border on conventional posterior-anterior chest radiographs in patients with rheumatic mitral stenosis is an unreliable indicator of the presence of thrombi in the left atrium or its appendage.
authors.affiliation: Department of Cardiovascular Radiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: M V
authors.initials: MV
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Aggarwal
authors.forename: V M
authors.initials: VM
authors.lastname: Reddy
authors.forename: U
authors.initials: U
authors.lastname: Kaul
authors.forename: M
authors.initials: M
authors.lastname: Rajani
authors.forename: P
authors.initials: P
authors.lastname: Venugopal
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006325:Heart Atria; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications*; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications*; D013927:Thrombosis / Q000000981:diagnostic imaging*