How to Diagnose and Treat Pulmonary Tumor Thrombotic Microangiopathy

Abstract

We report here a 70-year-old female patient with a history of breast cancer who presented with dyspnea that had lasted for 2 weeks following a long-distance trip by bus. She was at first suspected of having a pulmonary embolism given the typical presentation, elevated D-dimer level, and enlargement of the right-side heart. However, her systemic condition deteriorated despite the initiation of anti-coagulation therapy. Given the absence of a major thrombus in the pulmonary major arteries but multiple low perfusion lesions in the periphery of the lungs, refractoriness to conventional therapy, an increase in tumor markers, and anaplastic cells demonstrated by aspiration cytology from the pulmonary artery, we diagnosed her as pulmonary tumor thrombotic microangiopathy (PTTM). She died on day 23 due to respiratory failure despite administration of inotropes and prostaglandin I2. The patient had an obvious history of malignancy, but we should emphasize that PTTM can develop even in patients with early-stage or completely cured malignancies. Although an early and definite diagnosis of PTTM is currently challenging, an optimal diagnostic and therapeutic strategy is warranted.

Analysis on the Effects of CT- and Ultrasound-Guided Percutaneous Transthoracic Needle Biopsy Combined with Serum CA125 and CEA on the Diagnosis of Lung Cancer

“…Consequently, both examination modalities have certain limitations [4][5][6][7]. In addition to the two examination modalities mentioned above, serum tumor markers' detection has also become a hot spot of clinical research recently, though with the drawbacks of difficult localization, which can be fully used to carry out joint examinations with percutaneous transthoracic needle biopsy, increasing the accuracy of location and improving diagnostic rate [8][9][10][11]. Ultrasound-and CT-guided percutaneous transthoracic needle biopsy modalities are very common [12][13][14][15], with the former characterized by being minimally invasive and safe.…”

Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review

“…The search identified 48 eligible clinical articles with 59 cases of PTTM reported nationally and internationally, the remaining 14 articles were excluded due to recurrence or as they were review articles. Among them, 9 Chinese PTTM articles [13–21] were reported 16 cases; 39 English PTTM articles [1,22–59] were reported 43 cases.…”

Pulmonary Tumor Thrombotic Microangiopathy Caused by Metastatic Ovarian Cancer: An Antemortem Diagnosis with Pulmonary Aspiration Cytopathology

“…In hemodynamically unstable patients, immediate reperfusion therapy, including thrombolysis, percutaneous catheter-directed therapy, or surgical pulmonary embolectomy, accompanied by respiratory and hemodynamic support should be considered ( 8 , 9 ). However, although no established therapeutic guidelines have yet been developed, the recommended treatment strategy for PTTM differs from that for pulmonary embolism caused by deep venous thrombosis ( 10 ) due to the unique etiology of this rare disease condition.…”