Pulmonary Tumor Embolism and Pulmonary Tumor Thrombotic Microangiopathy Causing Rapidly Progressive Respiratory Failure: A Case Series

Rajdev, Kartikeya; Madan, Ujjwal; McMillan, Sean; Wilson, Kyle A.; Fisher, Kurt W.; Hein, Ashley L.; Patil, Amol; Bista, Sabin R.; Hershberger, Daniel; Boer, Brian

doi:10.1177/23247096221086453

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…Concerns are raised that tumoural PH is largely underdiagnosed as the clinical course often results in a rapid deterioration and fatal outcome before diagnostics are completed. 2 Post mortem studies have documented tumoural emboli in pulmonary microcirculation in ∼26% of patients with a solid tumour, markedly associated with adenocarcinoma, 3–5 whereas PTTM has been observed in ∼3.3% of patients with extrathoracic malignancies with highest frequency (26%) in gastric carcinomas. When PTTM is suspected ante mortem and RHC is performed, a blood sample of the pulmonary artery can be analysed for tumour cells to further confirm the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

An unexpected cause of pulmonary hypertension in a young woman: a case report

Aeberhard,

Lichtblau,

Arenja

2023

European Heart Journal - Case Reports

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Background Pulmonary hypertension (PH) is defined as a progressive disease that leads to right heart failure and death if untreated. This case report presents a young woman with reversible precapillary PH in the setting of a gastric cancer. Case Summary A 37-year-old woman presented with exertional dyspnea and syncope. The transthoracic echocardiographic findings were consistent with a cor pulmonale. Right heart catheterization proved a precapillary PH. Specific PH therapy with macitentan and tadalafil was initiated. Shortly thereafter, a gastric carcinoma was diagnosed and oncologic treatment with neoadjuvant chemotherapy and subsequent gastrectomy was promptly initiated. Retrospectively, we considered a pulmonary tumor thrombotic microangiopathy the most probable cause of PH. Follow-up after successful oncologic treatment and cumulative ten months of specific PH medication showed an excellent clinical response with complete remission of PH confirmed by RHC at rest. Discussion Tumor-related PH is very rare and might be largely underdiagnosed as the clinical course often results in a rapid deterioration and fatal outcome before diagnostics are completed. Post mortem studies have documented tumoral emboli in pulmonary microcirculation in up to 26% of patients with a solid tumor, markedly associated with adenocarcinoma. Pprompt initiation of cancer treatment on tumoral PH is essential. To our knowledge, this report documents the first full recovery of tumoral PH at rest after successful cancer treatment and temporary specific PH medication. We therefore conclude that a multidisciplinary approach with an initially combined oncologic and PH therapy may be most beneficial with the potential of complete remission of PH.

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Section: Discussionmentioning

confidence: 99%

An unexpected cause of pulmonary hypertension in a young woman: a case report

Aeberhard,

Lichtblau,

Arenja

2023

European Heart Journal - Case Reports

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“…Evidence-based findings supporting the use of anticoagulants, antibiotics, or steroid therapy in this entity are lacking. 9 Moreover, although both PTE and chronic thromboembolic pulmonary hypertension are classified as group 4 pulmonary hypertension, PTE is not considered amenable to standard pulmonary hypertension therapies because of its distinct pathophysiology. Unfortunately, PTE is often an end-stage presentation of advanced cancer, which commonly displays a rapid clinical course once respiratory symptoms ensue.…”

Section: Discussionmentioning

confidence: 99%

A Picture Is Worth 2,000 Words

Zadok

Padera

Nohria

2023

JACC: CardioOncology

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“…An invasive technique for the diagnosis of TE is represented by cytological examination of blood aspirated from a wedged pulmonary artery catheter, which could detect the tumor cells. The sensitivity of this technique is 80% to 88%, and specificity is 82 to 94% [ 94 ].…”

Section: Tumor Embolismmentioning

confidence: 99%

“…There is no specific treatment available for TE. Specific therapeutic measures for the primary tumor associated with treatment for pulmonary hypertension are indicated [ 94 ].…”

Section: Tumor Embolismmentioning

confidence: 99%

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

Sîrbu

Șorodoc

Floria

et al. 2023

JPM

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Nontrombotic pulmonary embolism represents the embolization of different types of materials (cells, organisms, gas, foreign material) into pulmonary circulation. The disease is uncommon, and clinical presentation together with laboratory findings are nonspecific. Its pathology is usually misdiagnosed based on imaging findings as pulmonary thromboembolism, but the correct diagnosis is essential because different therapeutic approaches are required. In this context, knowledge of the risk factors associated with nontrombotic pulmonary embolism and specific clinical symptoms is fundamental. Our objective was to discuss the specific features of the most common etiologies of nontrombotic pulmonary embolism, gas, fat, amniotic fluid, sepsis and tumors, to provide assistance for a rapid and correct diagnosis. Because the most common etiologies are iatrogenic, knowledge of the risk factors could be an important tool for prevention or rapid treatment if the disease develops during different procedures. The diagnosis of nontrombotic pulmonary embolisms represent a laborious challenge, and endeavors should be made to prevent development and increase awareness of this disease.

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Pulmonary Tumor Embolism and Pulmonary Tumor Thrombotic Microangiopathy Causing Rapidly Progressive Respiratory Failure: A Case Series

Cited by 7 publications

References 25 publications

An unexpected cause of pulmonary hypertension in a young woman: a case report

An unexpected cause of pulmonary hypertension in a young woman: a case report

A Picture Is Worth 2,000 Words

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

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