CONCLUSION
Progressive LA enlargement may be undetected and well-tolerated for a long time, even when it reaches massive proportions. When the LA enlarges to a gigantic size, a chest radiography is not sufficient to delineate the cause of cardiomegaly and can even be misleading. Echocardiogram is the most useful method for evaluating these patients. There is a poor correlation between the size of the LA and the severity of the MS, and our case serves to create awareness to clinicians to consider full diagnostic work up for enlarged LA as patients may not always have symptoms.