Symptoms to Diagnosis

Right ventricular failure in a young man

Keerthana Sankar, MD and Yuri Matusov, MD
Cleveland Clinic Journal of Medicine February 2026, 93 (2) 106-112; DOI: https://doi.org/10.3949/ccjm.93a.25048

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Chest radiograph obtained at admission was notable for consolidations in the left lower and middle lung field concerning for alveolar edema (white arrows); blunting of the left costophrenic angle, likely reflecting a small left pleural effusion (blue arrow); and scattered rounded lesions in the left lung field (red arrows). The cardiac silhouette appears enlarged, with a prominent, bulging right heart border (green arrow), suggesting possible right atrial enlargement and volume overload. The right lung field appears clear.

  • Figure 2
    Figure 2

    Transthoracic echocardiography apical 4-chamber view showed severe right ventricular dilation (white arrow), dilated right atrium (blue arrow), and flattening of the intraventricular septum (red arrow) consistent with right ventricular pressure and volume overload.

  • Figure 3
    Figure 3

    (A) Chest computed tomography with contrast demonstrated extensive mediastinal soft tissue infiltration (white arrow). (B) Calcified lymph nodes (red arrows), severe pulmonary artery enlargement with a diameter of 39.4 mm (blue double-head arrow), and narrowing of the bilateral pulmonary arteries (white arrow shows narrowing of the right pulmonary artery) were noted.

Tables

  • TABLE 1

    The patient’s initial laboratory results

    TestResultaReference range
    Sodium139 mmol/L135–146
    Potassium3.8 mmol/L3.5–5.3
    Chloride99 mmol/L98–110
    Bicarbonate32 mmol/L20–32
    Anion gap8 mEq/L10–20
    Blood urea nitrogen12.2 mg/dL7–25
    Creatinine1.2 mg/dL0.60–1.26
    Calcium9.5 mg/dL8.6–10.3
    White blood cell count9.15 × 109/L4–11
    Hemoglobin13.9 g/dL13–17
    Platelet count281 × 109/L150–450
    B-type natriuretic peptide2,257 pg/mL< 100
    Troponin I0.10 ng/mL< 0.04
    Lactate1.9 mmol/L0.5–2.2

    • ↵aOut-of-range results are shown in bold.

  • TABLE 2

    Clinical classification of pulmonary hypertension

    GroupDescriptionConsiderations
    1Pulmonary arterial hypertensionIdiopathic; associated with genetic conditions, drugs and toxins, connective tissue disease, human immunodeficiency virus infection, portal pulmonary hypertension, schistosomiasis, and congenital heart disease; pulmonary arterial hypertension with features of venous or capillary involvement; persistent pulmonary arterial hypertension of the newborn
    2Pulmonary hypertension secondary to left heart diseaseAssociated with heart failure with preserved or reduced ejection fraction, valvular heart diseases, or cardiovascular conditions leading to postcapillary pulmonary hypertension
    3Pulmonary hypertension secondary to lung diseaseAssociated with chronic obstructive pulmonary disease, emphysema, or both; interstitial lung disease; combined pulmonary fibrosis and emphysema; other parenchymal lung diseases; nonparenchymal restrictive diseases; hypoxia without lung disease; developmental lung diseases
    4Pulmonary hypertension associated with pulmonary artery obstructionRelated to chronic thromboembolic disease and other pulmonary artery obstructions
    5Pulmonary hypertension with unclear or multifactorial mechanismsRelated to hematologic disorders, systemic disorders (sarcoidosis, pulmonary Langerhans cell histiocytosis and neurofibromatosis type 1), metabolic disorders, chronic renal failure with or without hemodialysis, pulmonary tumor thrombotic microangiopathy, fibrosing mediastinitis, complex congenital heart disease

    • Based on information from reference 3.

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