Giant Left Atrium

A 59-year-old woman with a history of rheumatic heart disease presented with an eight-month history of increasing ascites. Her condition was complicated by mitral stenosis, which had required a Bjork–Shiley mitral-valve replacement 20 years earlier. Chest radiography showed massive cardiomegaly (Panels A and B). A computed tomographic scan of the chest (Panel C) revealed severe enlargement of the left atrium (LA), which measured 15.0 by 15.8 cm and filled the entire lower right hemithorax; the scan also revealed anterior displacement of the Bjork–Shiley valve (arrow) and compression of the left ventricle (LV), right ventricle (RV), and right atrium (RA) against . . .