Giant Atrial Dilatation: Systematic Review of Reported Cases from the Last Decade and an Illustrative Case with Dysphagia and Severe Dysphonia

<b>Background/Objectives:</b> Giant atrial chambers are rare but clinically important conditions, most often linked to rheumatic mitral valve disease, though they may also occur in congenital or other acquired disorders. Despite their low prevalence, they entail major hemodynamic, arrhythmogenic, and extracardiac risks. This study aimed to review recent evidence on giant atrial pathology-including giant left atrium (GLA), giant right atrium (GRA), and atrial appendage aneurysms-and to illustrate its relevance through cases of symptomatic extracardiac compression. <b>Methods:</b> A PubMed search on 15 September 2025 using "giant atrium" and limited to human, free full-text studies from the last 10 years yielded 93 results. After screening, 21 reports describing 24 cases were analyzed and compared with institutional experience. <b>Results:</b> GLA is most often defined by an anteroposterior diameter ≥6.5 cm or ≥8 cm, while criteria for GRA and appendage aneurysms remain inconsistent. Reported complications include atrial fibrillation, thromboembolism, and compression of mediastinal structures, with presentations such as dysphagia or airway obstruction. While valve surgery alone may suffice, many authors recommend concomitant atrial reduction or aneurysm resection in symptomatic patients. <b>Conclusions:</b> Giant atrial pathology, though uncommon, carries significant cardiac and extracardiac implications. Management should be individualized, and awareness of atypical manifestations is critical for timely diagnosis and treatment.