Left atrial enlargement chest x-ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. ; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. ; Varun Kumar, M.B.B.S. 
Chest x-ray findings of left atrial enlargement are:
- Double density sign: Occur when the right side of the left atrium pushes behind the right atrial border, appearing as a double density. If large enough it can actually reach beyond the border of the right atrium.
- Convex left atria appendage: usually reflect prior rheumatic heart disease
- Splaying of the carina
- Posterior displacement of the left main stem bronchus on lateral radiograph
- Superior displacement of the left main stem bronchus on frontal view
- Posterior displacement of a barium filled oesophagus or nasogastric tube
Images shown below are courtesy of Radiopedia.com.
Aside from the dirty lung due to emphysema and pneumonic infiltration in the lower right field you can notice a marked enlargement of the left atrium with splaying of the carina.