X-ray chest PA view showing prominent double atrial shadow (double atrial contour, shadow in shadow) to the right of the spine, suggestive of left atrial enlargement. Right border of the heart is significantly shifted to the right, indicating associated right atrial enlargement. Left atrial appendage is seen as a bulge along the middle region of left heart border (third mogul sign). Upper lobe vessels are quite prominent (inverted moustache sign, antler sign, cephalization), indicating pulmonary venous hypertension. All together the findings on the chest X-ray indicate severe mitral stenosis.
Comments from Dr. Jyothish Vijay: Inverted moustache sign, Grade 2 LA enlargement with double atrial shadow, splaying of carina (>90 degrees), third mogul sign of LA appendage, elevation and narrowing of left main bronchus and probable pulmonary bay obliteration can be seen.