Flat waist sign refers to the loss of concavity of the left heart border in left lower lobe atelectasis. Specifically, there is flattening of the contours of the aortic arch and main pulmonary artery on a symmetrical frontal chest radiograph due to slight right anterior oblique rotation of the heart.
References
Kattan KR, Wlot JF. Cardiac rotation in left lower lobe collapse. "The flat waist sign." Radiology. 1976 Feb;118(2):275-9.
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