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Tracheal Carinal Angle in Evaluating Left Atrial Size

Earl N. Silber, MD
Arch Intern Med. 1991;151(10):2096-2100. doi:10.1001/archinte.1991.00400100148027.
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To the Editor.——  The recent article by Taskin et al,1 regarding tracheal carinal angle and left atrial size, warrants some comment. Elevation of the left main bronchus due to left atrial enlargement has been recognized for more than 50 years. It has also been emphasized that this is not an early sign of left atrial enlargement.The left atrium enlarges first posteriorly, then to the right, next to the left, and, finally, superiorly. Thus, posterior expansion of the left atrium is the earliest and most certain sign of enlargement of this chamber. It may be discerned radiographically in the lateral or either of the oblique projections and is best demonstrated by displacement of the barium-filled esophagus. With progressive enlargement of the left atrium, a double atrial contour may be visible inside the right heart border in the posteroanterior projection, and the left atrial appendage bulges to the left forming


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