A patient is having Mitral stenosis. His x-ray will show all of the following finding except
**Core Concept**
Mitral stenosis is a valvular heart disease characterized by the narrowing of the mitral valve opening, leading to an obstruction of blood flow from the left atrium to the left ventricle. This results in an increase in left atrial pressure, which can lead to left atrial enlargement and other associated changes on chest radiography.
**Why the Correct Answer is Right**
In mitral stenosis, the left atrium is subjected to increased pressure and volume overload, leading to its enlargement. This enlargement is often reflected on a chest radiograph as an increased left atrial diameter or a "double density" sign, where the left atrial appendage is seen as a separate structure above the left ventricle. The enlarged left atrium may also push the esophagus upwards, resulting in a straightened or "sigmoid" appearance of the esophagus on the chest radiograph.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because a prominent left atrial appendage is often seen in mitral stenosis, and a double density sign is a characteristic finding on chest radiography.
**Option B:** This option is incorrect because left atrial enlargement can lead to upward displacement of the esophagus, resulting in a straightened or sigmoid appearance on chest radiography.
**Option C:** This option is incorrect because right atrial enlargement is not a direct consequence of mitral stenosis, although it may occur in advanced cases due to pulmonary hypertension.
**Clinical Pearl / High-Yield Fact**
In mitral stenosis, a "double density" sign on chest radiography can be a helpful clue to diagnose the condition, but it is essential to consider other clinical and echocardiographic findings to confirm the diagnosis.
**Correct Answer:** D.