Prominent upper lobe vessels in CXR in mitral stenosis – Medicine MCQ

Prominent upper lobe vessels in X-ray chest in mitral stenosis indicate:
a) Antler sign
b) Pulmonary venous hypertension
c) Cephalization
d) All of the above

Correct answer: d) All of the above

X-ray chest in a case of mitral stenosis showing prominent upper lobe vessels

X-ray features of mitral stenosis

• Mitral stenosis is associated with the development of pulmonary hypertension
• When the severity of pulmonary venous hypertension increases, there is a redistribution of pulmonary blood flow towards the upper lobes.
• This is known as cephalization.
• It is also known as ‘Antler sign’ and ‘Upturned moustache sign’.
• A shadow of the left atrium is seen overlying the right atrium – shadow in shadow sign / double atrial shadow.
• Left atrial dilatation leads to straightening of the left heart border and elevation of the left main bronchus.
• The pulmonary arteries are prominent due to pulmonary arterial hypertension
• Kerley B lines may be seen near the costophrenic angles due to thickened interlobular septa
• The right heart border can be shifted to the right indicating right atrial dilatation secondary to pulmonary hypertension and right ventricular hypertrophy.

Kerley B lines in a case of mitral stenosis

Read more on X-ray in mitral stenosis at: https://cardiophile.org/prominent-upper-lobe-vessels-in-mitral-stenosis/