Unusual Case of Right Ventricular Strain and Dysfunction
Journal of the American College of Cardiology
Background: Mediastinal neoplasms are a rare cause of right ventricular (RV) strain and dysfunction. We describe a case of carcinoma resulting in RV failure requiring urgent radiation therapy. Case: 60 year old male presented with new onset chest pain and shortness of breath. Initial echocardiogram revealed mildly reduced left ventricular function with normal RV function and a large, predominately posterior pericardial effusion (Figure 1A).Decision-making: Given the posterior location of the effusion, pericardiocentesis was technically challenging and the decision was made to proceed with a pericardial window. A CT scan was completed to define the pericardium and was most notable for a 10 cm mass with pericardial invasion. Decision was made to forego pericardial window in favor of pericardiocentesis. Post-procedurally, he developed significant atrial arrhythmias and hypotension. A repeat CT demonstrated compression of the main pulmonary artery (PA) with RV/LV ratio of 1.5 (Figure 1B). Repeat echocardiogram revealed severe RV enlargement and dysfunction (Figure 1C). Biopsy of the mass identified a poorly differentiated carcinoma and the patient underwent emergent radiation and chemotherapy. After treatment, he stabilized clinically and repeat CT revealed reduction in the size of the mass and improvement of PA compression. Conclusion: The etiology of RV strain is broad. Mediastinal neoplasms with mass effect on the PA and subsequent RV failure requires rapid identification and treatment.
Khreisat A, Hanna M, Mando R, Allen O, Timmis SBH. Unusual cause of right ventricular strain and dysfunction. J Am Coll Cardiol. 2023 Mar;81(8 Suppl.A):3551. doi:10.1016/S0735-1097%2823%2903995-5