Three cases of pulmonary tumor thrombotic microangiopathy (PTTM): Challenge in antemortem diagnosis using lung perfusion blood volume images by dual-energy computed tomography

Kamada, Hiroki; Ota, Hideki; Terui, Yosuke; Sugimura, Koichiro; Fukui, Shigefumi; Shimokawa, Hiroaki; Takase, Kei

doi:10.1016/j.ejro.2020.01.001

Cited by 8 publications

(5 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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.…”

Section: Literature Review Resultsmentioning

confidence: 99%

Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review

Ma,

Gao,

Wang

et al. 2024

Medicine

View full text Add to dashboard Cite

Rationale: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but serious complication in patients with malignancy; its main manifestation includes acute pulmonary hypertension with severe respiratory distress. More than 200 cases have been reported since it was first identified in 1990. PTTM accounts for approximately 0.9% to 3.3% of deaths due to malignancy, but only a minority of patients are diagnosed ante-mortem, with most patients having a definitive diagnosis after autopsy. Patient concerns: Two middle-aged women both died within a short period of time due to progressive dyspnea and severe pulmonary hypertension. Diagnoses: One patient was definitively confirmed as a gastrointestinal malignant tumor by liver puncture biopsy pathology. Ultimately, the clinical diagnosis was pulmonary tumor thrombotic microangiopathy. Interventions: The patient was treated symptomatically with oxygen, diuresis, and anticoagulation, while a liver puncture was perfected to clarify the cause. Outcomes: Two cases of middle-aged female patients with rapidly progressive pulmonary hypertension and respiratory failure resulted in death with malignant neoplasm. Lessons: PTTM has a rapid onset and a high morbidity and mortality rate. Our clinicians need to be more aware of the need for timely diagnosis through a targeted clinical approach, leading to more targeted treatment and a better prognosis.

show abstract

Section: Literature Review Resultsmentioning

confidence: 99%

Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review

Ma,

Gao,

Wang

et al. 2024

Medicine

View full text Add to dashboard Cite

show abstract

“…Several attempts at making an early diagnosis of PTTM by less invasive means have been reported. Kamada et al reported identifying specific findings for PTTM in three patients by lung perfusion blood volume imaging on dual-energy computed tomography [ 9 ]. Mitsui et al suggested cytological examination of blood sampled via a right heart catheter [ 10 ], previous studies having shown that cytological examination of blood obtained via a wedged pulmonary artery catheter has a sensitivity of 80%–88% and a specificity of 82%–94% [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary tumor thrombotic microangiopathy during good response to immuno-chemotherapy for advanced non-small cell lung cancer: a case report

et al. 2023

View full text Add to dashboard Cite

Background Pulmonary tumor thrombotic microangiopathy is a rapidly progressive and fatal disease in which tumor cells embolize to the pulmonary microvasculature. This condition is characterized by severe dyspnea and right heart failure. Although pulmonary tumor thrombotic microangiopathy typically occurs in patients with untreated and/or advanced cancer, its occurrence in patients who are responding well to medical therapy is poorly documented. Case presentation A 68-year-old Japanese woman who had received four cycles of immuno-chemotherapy (pembrolizumab, carboplatin, and pemetrexed) followed by three cycles of maintenance therapy (pembrolizumab and pemetrexed) for advanced non-small cell lung cancer and had achieved a partial response with a stable clinical course was admitted to the emergency ward because of worsening breathlessness and general fatigue for 1 week. Chest computed tomography showed no evidence of tumor progression or any new lung lesion. Two-dimensional transthoracic echocardiography demonstrated right atrial and ventricular dilatation, tricuspid regurgitation, and a high trans-tricuspid pressure gradient of 65 mmHg. Despite her percutaneous oxygen saturation being 96% on room air at the time of admission, it worsened rapidly; the patient requiring 8 L/min of oxygen within 4 h. Repeat computed tomography with contrast medium revealed no evidence of pulmonary embolism. The patient developed progressive respiratory failure that was unresponsive to optimal cardio-pulmonary supportive therapy. An autopsy revealed tumorous clusters in pre-capillary lung vessels, whereas the primary lesion had shrunk to the point of almost complete resolution. Conclusion Pulmonary tumor thrombotic microangiopathy occurs not only in patients with advanced and/or uncontrolled cancer but also in those whose primary lesion seems to have been well controlled by medical treatment.

show abstract

“…Other helpful diagnostic tools include computed tomography pulmonary angiography, which will generally be negative for pulmonary embolism [ 2 ], and echocardiogram, which will often demonstrate significant pulmonary hypertension and right heart strain [ 6 ]. One case series submitted to the European Journal of Radiology suggests that lung-perfused blood volume images obtained by dual-energy computed tomography may provide a benefit in diagnosing PTTM antemortem [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Tumor Thrombotic Microangiopathy Caused by Esophageal Adenocarcinoma: A Case Report

Peeples,

King,

Chung

et al. 2023

Cureus

View full text Add to dashboard Cite

Pulmonary tumor thrombotic microangiopathy (PTTM ) is a rare condition of uncertain incidence given its likely underdiagnosis. PTTM has been described most frequently in association with gastric adenocarcinoma, but other primary malignancies have been identified. The prognosis of PTTM is very poor, and patients often die within days or weeks of diagnosis. There are, however, several medications currently being used with unknown therapeutic benefits. The case presented below describes a patient with PTTM and esophageal adenocarcinoma, which may be the first report of its kind. One other case of esophageal cancer associated with PTTM was found in the literature review, but it is of squamous cell carcinoma histology. Herein, we report a case of a male with rapidly progressive pulmonary hypertension and right heart failure who, in the course of treatment/evaluation, was found to have esophageal adenocarcinoma. While early diagnosis may not alter the course of the disease, antemortem diagnosis may identify better therapeutic options and better inform patients of their prognosis, allowing them to maintain autonomy in their medical decisions.

show abstract

Three cases of pulmonary tumor thrombotic microangiopathy (PTTM): Challenge in antemortem diagnosis using lung perfusion blood volume images by dual-energy computed tomography

Cited by 8 publications

References 14 publications

Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review

Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review

Pulmonary tumor thrombotic microangiopathy during good response to immuno-chemotherapy for advanced non-small cell lung cancer: a case report

Pulmonary Tumor Thrombotic Microangiopathy Caused by Esophageal Adenocarcinoma: A Case Report

Contact Info

Product

Resources

About