Pulmonary tumour thrombotic microangiopathy (PTTM) is characterised by wide spread tumour emboli along with fibrocellular intimal proliferation and thrombus formation in small pulmonary arteries and arterioles. PTTM is a rare but fatal complication of carcinoma, but the pathogenesis remains to be clarified. An autopsy case of PTTM caused by gastric adenocarcinoma is described, in which tumour cells in the PTTM lesion had positive immunoreactivity for platelet-derived growth factor (PDGF) and PDGF receptor (PDGFR), and proliferating fibromuscular intimal cells also showed expression of PDGFR. In addition, the overexpression of PGDF was detected in the alveolar macrophages. These findings suggest that PDGF derived from alveolar macrophages and from tumour cells may act together in promoting fibrocellular intimal proliferation. To the best of the authors' knowledge, the possible involvement of activated alveolar macrophages in PTTM has not been previously reported.

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A 73-year-old female was transferred to our hospital with respiratory distress, and suffered a cardiac arrest (CA) after her arrival. We immediately started cardiopulmonary resuscitation (CPR), during which we use a mechanical chest compression device, the AutoPulse ® (Asahi Kasei ZOLL Medical Corporation). We diagnosed the patient with a CA caused by a pulmonary thromboembolism. Although her hemodynamics were well maintained following the return of spontaneous circulation, they suddenly became unstable 15 hours after her admission to the ICU. Then, progressive anemia was detected. Abdominal ultrasonography and CT revealed injuries to the liver and spleen and multiple rib fractures; hence, we diagnosed the patient with hypovolemic shock. We performed splenectomy and coagulative hemostasis for the liver laceration. Conclusion: It was suggested that the shifting of the AutoPulse ® band to the caudal side due to the patient's obesity (BMI 38 kg/m 2), might have caused these complications. When using mechanical chest compression devices, clinicians should be familiar with its characteristics, and must take care to avoid complications.

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