Endomyocardial fibrosis with mitral stenosis
X-ray chest PA view of a person with right ventricular endomyocardial fibrosis and mitral stenosis. Though the film is mildly rotated to the right, the prominent right atrial shadow is due to endomyocardial fibrosis involving the right ventricle producing right atrial enlargement. The prominent upper lobe veins are due to pulmonary venous congestion secondary to mitral stenosis. Though a similar picture can occur due to left ventricular endomyocardial fibrois, in this case there was rheumatic mitral stenosis for which a closed mitral valvotomy was done earlier. The current presentation was with mitral restenosis which was once again relieved by balloon mitral valvotomy. The right atrial enlargement in a case of mitral stenosis can be secondary to pulmonary hypertension or tricuspid valve disease (stenosis or regurgitation). But here it was mostly due to right ventricular endomyocardial fibrosis, demonstrated by echocardiography.