Pulmonary Tumor Thrombotic Microangiopathy Associated with Advanced Gastric Cancer Successfully Treated with Chemotherapy

Yoo, S. S.; Park, Kwonoh; Hong, Ji Yeon; Kim, Ji Yeon; Park, Jang Won; Park, Yong Won; Lee, Kyung-Hun; Jeon, Kyung-So

doi:10.12771/emj.2014.37.2.146

Cited by 1 publication

(2 citation statements)

References 11 publications

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“…Treatments being tried for PTTM includes systemic chemotherapy, anticoagulant therapy, steroid therapy and treatments for PH [ 1 , 16 , 17 , 18 ]. Anti-tumor drugs such as imatinib (a platelet-derived growth factor receptor inhibitor) and bevacizumab (a vascular endothelial growth factor receptor inhibitor) are under trial as they may have a role in reducing vascular remodeling [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…The median TR Vmax (IQR) was 3.8 (3.5-3.8) m/s, and the median RVSP was 63 (58-79) mmHg, indicating severe PH. The median value of TAPSE (n = 7) was 15 (11)(12)(13)(14)(15)(16)(17) mm, showing a decrease in RV systolic function, with one patient having a normal value of 21 mm. The values of S' (n = 4) ranged from 7.7 to 11.9 cm/s.…”

Section: Echocardiography Findingsmentioning

confidence: 99%

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Echocardiographic Assessment of Patients with Pulmonary Tumor Thrombotic Microangiopathy First Diagnosed in the Emergency Department

Kim

Yoon

et al. 2022

Diagnostics

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Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease that obstructs pulmonary vessels, leading to pulmonary hypertension (PH) and right-sided heart failure causing rapid progressive dyspnea in patients with cancer. This retrospective chart review involved nine patients with PTTM who were first clinically diagnosed in a tertiary emergency department (ED) between January 2015 and June 2021. They underwent laboratory tests, chest radiography, chest computed tomography (CT), and echocardiography. All patients presented with severe and rapidly progressive dyspnea within a few days, a high oxygen demand. The right ventricle (RV): left ventricle ratio was >1 on chest CT, and no life-threatening pulmonary thromboembolism (PTE) was observed. Echocardiographic findings indicated that all patients had moderate-to-severe RV dilatation with a D-shaped LV. The median tricuspid regurgitation maximum velocity was 3.8 m/s, and the median RV systolic pressure was 63 mmHg, indicating severe PH. The median value of tricuspid annular plane systolic excursion was 15 mm, showing a decrease in RV systolic function, and McConnell’s sign was observed in five patients. Two patients immediately underwent chemotherapy and are currently alive. PTTM should be suspected and evaluated using echocardiography in patients with cancer presenting to the ED with acute dyspnea and RV failure without PTE.

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