Related Experiment Videos
Chest radiographs are unreliable in predicting thrombi in the left atrium or its appendage in rheumatic mitral
S Sharma1, M V Kumar, S Aggarwal
1Department of Cardiovascular Radiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.
Insights
A flat or concave left mid-cardiac border on chest X-rays is an unreliable indicator for detecting left atrial thrombi in patients with rheumatic mitral stenosis. This imaging finding showed low sensitivity and specificity for predicting blood clots in the left atrium or appendage.
Area of Science:
- Radiology
- Cardiology
- Cardiac Surgery
Background:
- Rheumatic mitral stenosis frequently leads to left atrial enlargement and thrombus formation.
- Accurate detection of left atrial thrombi is crucial for preventing thromboembolic complications.
- Conventional chest radiography is a widely available imaging modality.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a specific radiographic finding (flat or concave left mid-cardiac border) in predicting left atrial thrombi.
- To determine the sensitivity, specificity, and predictive values of this sign in patients with rheumatic mitral stenosis.
Main Methods:
- Retrospective analysis of 80 patients with rheumatic mitral stenosis undergoing open-heart surgery.
- Correlation of pre-operative postero-anterior chest radiographs with surgical findings of left atrial or appendage thrombi.
- Assessment of the left mid-cardiac border morphology (flat or concave) on radiographs.
Main Results:
- Only 48% of patients with left atrial thrombi showed a flat or concave left mid-cardiac border (sensitivity).
- The specificity of this finding was 53%, with a positive predictive value of 58%.
- In cases where the thrombus involved the left atrial appendage, sensitivity dropped to 42%.
Conclusions:
- The presence of a flat or concave left mid-cardiac border on chest radiographs is an unreliable predictor of left atrial thrombi in rheumatic mitral stenosis.
- This radiographic sign has limited diagnostic value for identifying patients at risk of thrombosis.
- Alternative or additional imaging modalities are necessary for accurate thrombus detection in this patient population.
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.