A 62-year-old woman with long-standing rheumatic mitral stenosis presents with progressive difficulty swallowing solids. Barium swallow shows an extrinsic posterior indentation of the mid-esophagus with no mucosal irregularity. Which cardiac chamber is responsible for this compression?

• A Right atrium
• B Right ventricle
• C Left ventricle
• D Left atrium ✓

Explanation

The left atrium is the most posterior chamber of the heart and lies directly anterior to the upper thoracic esophagus at the T6 to T8 level. Enlargement from mitral stenosis produces this characteristic smooth posterior esophageal impression, historically called dysphagia megalatriensis. This same close relationship is why transesophageal echocardiography gives excellent views of the left atrium and mitral valve. The right atrium and both ventricles lie more anteriorly and cannot indent the esophagus.

Reference: Gray's Anatomy for Students, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.