Right Ventricular Failure From Malignant Pulmonary Artery Compression.

CASE SUMMARY: A 31-year-old woman presented with progressive dyspnea, orthopnea, cough, fatigue, and marked weight loss. Multimodality imaging demonstrated metastatic pancreatic malignancy with malignant pericardial effusion, a contrast-enhancing left ventricular apical mass, and right ventricular pressure overload. Contrast-enhanced computed tomography revealed extrinsic compression of the right pulmonary artery by mediastinal lymphadenopathy, causing functional supravalvular stenosis. She developed tamponade physiology, obstructive shock, and renal dysfunction; palliative discharge was agreed on after discussion.

DISCUSSION: Malignant pulmonary artery compression is a rare mimic of pulmonary embolism and may present with unexplained right ventricular failure in patients with advanced cancer.

TAKE-HOME MESSAGE: In patients with cancer with unexplained right ventricular failure, malignant pulmonary artery compression should be considered. Multimodality imaging distinguishes this entity from pulmonary embolism or pulmonary hypertension.