Subacute pulmonary hypertension due to pulmonary tumor thrombotic microangiopathy from gastric cancer: A case report

Masahide Harada, Yuhtaro Nishi, Noriaki Hayashida, Hitoshi Koyanagi

Research output: Contribution to journalArticle

Abstract

A 45-year-old man with acute progressive dyspnea was admitted to our hospital. His consciousness was clear, but he was hypotensive. ECG and an echocardiogram demonstrated right ventricular overload and pulmonary hypertension, so a diagnosis of acute pulmonary embolisms was considered. Chest computed tomography and pulmonary angiography showed no evidence of the thrombus. However, catheterization revealed severe pulmonary hypertension (systolic pulmonary artery pressure 80-90 mmHg). Pulmonary perfusion scintigraphy demonstrated diffuse perfusion defect, consistent with multiple pulmonary microembolisms. The pulmonary hypertension resisted all medical treatment and was progressive. On the second hospital day, the patient suffered cardiac arrest and cardiopulmonary resuscitation was initially successful. Hemodynamic stability was temporally maintained using intra-aortic ballon pumping and percutaneous cardio-pulmonary support. However, because hypoxic brain damage was severe and pulmonary hypertension was progressive, the patient died on the third hospital day. Autopsy revealed type IV progressive gastric cancer with multiple metastasis, and pulmonary tumor thrombotic microangiopathy (PTTM) from the gastric cancer. The direct cause of death was pulmonary hypertension secondary to PTTM. PTTM is a difficult antemortem diagnosis to make and carries a very poor prognosis.

Original languageEnglish
Pages (from-to)879-885
Number of pages7
JournalRespiration and Circulation
Volume53
Issue number8
Publication statusPublished - 01-08-2005
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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