Abstract
Background: Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition involving the development of pulmonary hypertension caused by the presence of microscopic tumor emboli of peripheral pulmonary arteries . Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer, which was identified after the patient’s death through a pathological autopsy.Case presentation: Four days before a 52-year-old Asian woman, whose initial symptom was the occurrence of anterior chest pain while coughing, visited the emergency department of Gifu University Hospital, she had been diagnosed as having multiple osteolytic bone metastases throughout her body; for the detection of a primary lesion, she was scheduled to undergo combined positron emission tomography and computed tomography (CT) at a later date. However, she was unable to stand up, and consequently, she visited the emergency department. At the time of admission, the results of a physical examination revealed that while breathing room air, she had a percutaneous oxygen saturation level of 90% and cyanosis, and she was in a state of hemodynamic shock; laboratory-test data revealed the presence of elevated levels of fibrin degradation products and D-dimer in her blood. The results of chest CT were normal. She was admitted to the hospital’s general ward for follow-up; however, she was soon in a further state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was transported to an intensive care unit of the hospital and treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made. Conclusion: In cases involving patients with carcinoma of unknown primary site and pulmonary hypertension, if CT scan rules out pulmonary embolism, emergency physicians and intensivists must consider the possibility of the patients having PTTM, which represents an oncologic emergency, and initiate the administration of chemotherapy as soon as possible.
Pulmonary Tumor Thrombotic Microangiopathy as a Cause of Pulmonary Hypertension
