Right ventricular enlargement

Last revised by Daniel J Bell on 4 Aug 2019

Right ventricular enlargement (also known as right ventricular dilatation (RVD)) can be the result of a number of conditions, including:

Clinical presentation

  • right axis deviation
  • secondary repolarization (ST-T) abnormalities (leads V1-3)
  • deep S waves in lateral (I, aVL, V5-6) leads
  • tall, prominent R waves in lead V1
    • may be masked in the presence of COPD

Radiographic features

Plain radiograph

Frontal view demonstrates:

  • rounded left heart border
  • uplifted cardiac apex

Lateral view demonstrates:

  • filling of the retrosternal space
  • rotation of the heart posteriorly

On transthoracic echocardiography the apical 4 chamber (A4C) view allows a qualitative assessment of the presence or absence of right ventricular enlargement, as well as the degree of severity 4:

  • mild RV enlargement
    • basal diameter increased (>4.2 cm)
    • left ventricular size still exceeds that of the RV
  • moderate RV enlargement
    • the size of the RV approximates that of the left ventricle (LV)
    • the left ventricle still forms apex
  • severe RV enlargement
    • the RV forms the apex and is larger than the LV

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Cases and figures

  • Figure 1: normal PA cardiomediastinal outlines
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  • Figure 2: diagram (frontal)
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  • Figure 3: diagram (frontal)
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  • Figure 4: diagram (lateral)
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  • Figure 5: diagram (lateral)
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  • Case 1: tetralogy of Fallot
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