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International Journal of Anatomy, Radiology and Surgery, 2015 Apr, Vol-4(2): 16-17
16
ID: IJARS/2015/13946:2042
Images in Medicine
Radiology Section
Walking Man with A Large Heart
RAGHAVENDRA BHAT, PARUL KODAN, MEENAKSHI SHETTY
Enlargement of left atrium acts as a predictor of cardiovascular
outcomes such as atrial fibrillation, stroke, congestive heart
failure, cardiovascular death and also reflects diastolic burden
[1]. Although echocardiogram acts as an accurate tool to
precisely measure left atrial enlargement in most clinical
setup, the treating physician in less equipped setup can get
loads of information by carefully looking at the black and white
image of chest roengtogram. This cheap imaging tool may
show double density sign, enlarged carinal angle [2] and the
lateral view may beautifully depict a walking man [Table/Fig-1].
The Chest X Ray can thus act as preliminary tool to give the
clue for left atrium enlargement. Posterior displacement of left
main bronchus due to left atrial enlargement, gives an image
of inverted V, which mimics the legs of a walking man [3]. Our
image shows this classical walking man sign in a patient with
long standing mitral stenosis [Table/Fig-2a,b].
Chest X-Ray Lateral View showing Walking Man Sign due to
left atrial enlargement.
LEARNING POINT OVERVIEW
• Strong evidence suggests that left atrial enlargement has
clinical significance in patient with cardiovascular disease.
• Chest X-ray can give clue to the physician about left atrial
enlargement.
• Walking man sign is a classical sign of left atrial enlargement
seen in chest X ray lateral view.
[Table/Fig-1]: Walking Man Sign
[Table/Fig-2a-b]: (a)On right lateral Chest X-Ray shows normal
position of left and right bronchus.
(b) On left the Chest X-Ray lateral view shows Lt main bronchus
has moved like a walking man’s left foot -representing posteriosu-
perior shifting of lt main bronchus due to lt atrial enlargment. This
is known as “WALKING MAN SIGN” because it looks as if the man
has moved his left foot forward!
http://ijars.jcdr.net Raghavendra Bhat et al., Walking Man With A Large Heart
International Journal of Anatomy, Radiology and Surgery, 2015 Apr, Vol-4(2): 16-17 17
AUTHOR(S):
1. Dr. Raghavendra Bhat
2. Dr. Parul Kodan
3. Dr. Meenakshi Shetty
PARTICULARS OF CONTRIBUTORS:
1. Professor and Head, Department of Medicine,
Kasturba Medical College, Manipal University,
Mangalore, Karnataka, India.
2. Post Graduate Student, Department of Medicine,
Kasturba Medical College, Manipal University,
Mangalore, Karnataka, India.
3. Associate Professor, Department of Medicine,
Kasturba Medical College, Manipal University,
Mangalore, Karnataka, India.
NAME, ADDRESS, E-MAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Raghavendra Bhat,
Head of the Department ,Department of Medicine, Kasturba
Medical College, Mangalore, Karnataka, India.
E-mail: nita2005bhat@yahoo.co.in
FINANCIAL OR OTHER COMPETING INTERESTS:
None.
Date of Publishing: Apr 10, 2015
REFERENCES
[1] Patel DA, Lavie CJ, Milani RV, Shah S, Gilliland Y. Clinical
implications of left atrial enlargement: a review. Ochsner J.
2009;15:191–96.
[2] Taskin V, Bates MC, Chillag SA.Tracheal carinal angle and left
atrial size. Arch Intern Med.1991 Feb;151(2):307-08.
[3] Brant WE, Helms C. Fundamentals of Diagnostic Radiology.
Lippincott Williams & Wilkins. (2012) ISBN:1608319113.
