Mini‐AbstractA 58‐year‐old woman with a history of mitral valve replacement (MVR) 17 years ago and was admitted to our clinic with dyspnea. Transthoracic examination showed a normal functioning MVR with a very large left atrium which was 209 × 96 mm that was not possible to fit the screen in its entirety. Left atrial enlargement may be misdiagnosed as pleural effusion or a mass, so the clinician must be alert to avoid from further invasive examinations like pleurocentesis or biopsy, which may be associated with dangerous complications.