Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report
Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastr...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | International Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12245-021-00377-2 |
| _version_ | 1818664279590567936 |
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| author | Ryo Kamidani Keisuke Kumada Hideshi Okada Genki Yoshimura Tomohiro Kanayama Hiroyuki Tomita Tomotaka Miura Hideaki Oiwa Yosuke Mizuno Yuichiro Kitagawa Ryu Yasuda Tetsuya Fukuta Takahito Miyake Tomoaki Doi Takahiro Yoshida Shozo Yoshida Akira Hara Shinji Ogura |
| author_facet | Ryo Kamidani Keisuke Kumada Hideshi Okada Genki Yoshimura Tomohiro Kanayama Hiroyuki Tomita Tomotaka Miura Hideaki Oiwa Yosuke Mizuno Yuichiro Kitagawa Ryu Yasuda Tetsuya Fukuta Takahito Miyake Tomoaki Doi Takahiro Yoshida Shozo Yoshida Akira Hara Shinji Ogura |
| author_sort | Ryo Kamidani |
| collection | DOAJ |
| description | Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy. Case presentation A 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening 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 admitted to the intensive care unit and was 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. Conclusions In patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible. |
| first_indexed | 2024-12-17T05:30:13Z |
| format | Article |
| id | doaj.art-6fe7e2dd89b043939ad7358d2e94302b |
| institution | Directory Open Access Journal |
| issn | 1865-1372 1865-1380 |
| language | English |
| last_indexed | 2024-12-17T05:30:13Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Emergency Medicine |
| spelling | doaj.art-6fe7e2dd89b043939ad7358d2e94302b2022-12-21T22:01:44ZengBMCInternational Journal of Emergency Medicine1865-13721865-13802021-09-011411610.1186/s12245-021-00377-2Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case reportRyo Kamidani0Keisuke Kumada1Hideshi Okada2Genki Yoshimura3Tomohiro Kanayama4Hiroyuki Tomita5Tomotaka Miura6Hideaki Oiwa7Yosuke Mizuno8Yuichiro Kitagawa9Ryu Yasuda10Tetsuya Fukuta11Takahito Miyake12Tomoaki Doi13Takahiro Yoshida14Shozo Yoshida15Akira Hara16Shinji Ogura17Advanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalDepartment of Tumor Pathology, Gifu University Graduate School of MedicineDepartment of Tumor Pathology, Gifu University Graduate School of MedicineAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalAdvanced Critical Care Center, Gifu University HospitalDepartment of Tumor Pathology, Gifu University Graduate School of MedicineAdvanced Critical Care Center, Gifu University HospitalAbstract Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy. Case presentation A 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening 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 admitted to the intensive care unit and was 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. Conclusions In patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible.https://doi.org/10.1186/s12245-021-00377-2Pulmonary tumor thrombotic microangiopathyPulmonary hypertensionTumor microembolismOncologic emergency |
| spellingShingle | Ryo Kamidani Keisuke Kumada Hideshi Okada Genki Yoshimura Tomohiro Kanayama Hiroyuki Tomita Tomotaka Miura Hideaki Oiwa Yosuke Mizuno Yuichiro Kitagawa Ryu Yasuda Tetsuya Fukuta Takahito Miyake Tomoaki Doi Takahiro Yoshida Shozo Yoshida Akira Hara Shinji Ogura Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report International Journal of Emergency Medicine Pulmonary tumor thrombotic microangiopathy Pulmonary hypertension Tumor microembolism Oncologic emergency |
| title | Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report |
| title_full | Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report |
| title_fullStr | Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report |
| title_full_unstemmed | Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report |
| title_short | Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report |
| title_sort | postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer a case report |
| topic | Pulmonary tumor thrombotic microangiopathy Pulmonary hypertension Tumor microembolism Oncologic emergency |
| url | https://doi.org/10.1186/s12245-021-00377-2 |
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