Korean J Med.  2014 Nov;87(5):593-597. 10.3904/kjm.2014.87.5.593.

A Case of Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Advanced Gastric Cancer

• Jun JE
• Kim JH
• Ryu DH
• Lee JE
• Jeong HJ
• Yang JH

• KMID: 2269202
• DOI: http://doi.org/10.3904/kjm.2014.87.5.593

Abstract

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.

Keyword

Pulmonary tumor thrombotic microangiopathy; Pulmonary hypertension; Gastric cancer

MeSH Terms

Biopsy
Cardiac Catheterization
Cardiac Catheters
Dyspnea
Echocardiography
Heart Atria
Heart Failure
Heart Ventricles
Humans
Hypertension, Pulmonary
Lung
Male
Middle Aged
Perfusion
Pulmonary Embolism
Stomach Neoplasms*
Thoracic Surgery, Video-Assisted
Thorax
Thrombotic Microangiopathies*
Ventricular Function, Left