Largest giant left atrium in rheumatic heart disease.

In the current era of echocardiography, early diagnosis and treatment of rheumatic heart disease make giant left atrium a rare condition, with a reported incidence of 0.3%, and following mainly with rheumatic mitral valve disease. We report a 50-year-old female, a known case of rheumatic heart disease who presented with breathlessness and dysphagia, and the cardiothoracic ratio on chest roentgenogram was 0.95. Echocardiography was suggestive of giant left atrium with a size of 19.4 x 18.3 cm, while magnetic resonance imaging revealed a size of 22.3 x 19.2 x 20.1 cm making it the largest left atrium to be reported in the literature. <Learning objective: Giant left atrium is extremely rare in the current era, and if at all present, it is almost always secondary to rheumatic heart disease. These patients will have long duration of rheumatic heart disease, more chance of atrial fibrillation, compressive symptoms, and thromboembolism. Giant atrium is an indication for anticoagulation even if it is in sinus rhythm.>.