X-ray manifestations of left atrial enlargement in mitral stenosis are biventricular changes, straightening of the left heart margin, elevation of the left main bronchus, and signs of esophageal compression. In mitral stenosis, during diastole, the blood in the left atrium cannot reach the left ventricle through the mitral valve in time, and the blood is stagnant, causing enlargement of the left atrium. X-ray manifestations include an increased density shadow behind the edge of the right atrium on the posterior anterior chest film, showing biventricular changes; the left atrium is protruding, causing the left cardiac edge to straighten; the left atrium can be seen in the left anterior oblique position, causing the left main bronchus to be uplifted; and the left atrium can be seen to be enlarged in the right anterior oblique position on the esophageal angiogram, which compresses the esophagus, resulting in the sign of esophageal compression. In addition to mitral stenosis, there is also narrowing of the aortic arch, protrusion of the pulmonary artery due to pulmonary hypertension, enlargement of the right ventricle, and pear-shaped changes in the heart. It is recommended to improve the X-ray examination, the doctor combined with cardiac ultrasound, physical examination, clinical symptoms and other aspects of analysis, comprehensive treatment.