A chest radiograph of a 40-year-old patient shows straightening of the left heart border, a double density at the right heart border, and elevation of the left main bronchus. These findings together are most consistent with:

• A Left ventricular hypertrophy
• B Pericardial effusion
• C Right atrial enlargement
• D Left atrial enlargement ✓

Explanation

Left atrial enlargement produces a triad of findings on the PA chest radiograph: a double density at the right cardiac border (representing the posterior left atrial wall projected through the right atrium), straightening or convexity of the left heart border at the level of the left atrial appendage, and carinal splaying with elevation of the left main bronchus due to posterior and superior atrial expansion. These signs reflect the posterior and superior position of the left atrium within the cardiac silhouette. This is classically associated with mitral stenosis.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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