Subacute Cor Pulmonale

Brill, I. C.

doi:10.1001/archinte.1937.00180060096010

Cited by 85 publications

(24 citation statements)

References 7 publications

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“…Pulmonary tumour embolism (PTUE), characterised by the occlusion of pulmonary vessels by tumour cells, was described more than 100 years ago [138]. It was not until 1937 that cor pulmonale due to emboli to the pulmonary microvasculature was described [139].…”

Section: Tumour Embolismmentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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Section: Tumour Embolismmentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

European Respiratory Journal

161

127

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“…Pulmonary tumor thrombotic microangiopathy (PTTM) is a is a rare complication of pulmonary malignancies and this term was first used in 1990 by Von Hervay et al [2] but it was first defined in 1937 by Brill and Robertson as ''subacute cor pulmonale'' [3]. Cancer related thrombocytopenia can result either from bone marrow metastasis or as a paraneoplastic process [4].…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the Lung Presenting as Thrombotic Thrombocytopenic Purpura

Dirweesh

2016

Chest

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a b s t r a c tAcquired thrombotic thrombocytopenic purpura (TTP) usually presents as severe microangiopathic hemolytic anemia (MAHA) and thrombocytopenia in a previously healthy individual. It occurs in approximately three in one million adults and 1 in 10 million children annually. The incidence is increased in females and blacks. Diagnosing TTP and initiating therapy with plasma exchange is a must to avoid preventable complications. Acquired thromotic microangiopathy has been linked to collagen vascular diseases, use of certain medications, organ transplants, infections, pregnancy and cancer. We report a rare case of a 56-year-old African American male diagnosed with TTP who found to have an asymptomatic adenocarcinoma of the lung. Prompt cancer management resulted in completed remission of the thrombotic microangiopathy.

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“…PTE was first reported by Brill and Robertson in 1937, 6 who described a case of rapid development of right heart failure due to tumour emboli. PTE is characterised by occlusion of small pulmonary arteries, arterioles and alveolar septal capillaries by aggregates of tumour cells accompanied by platelet-fibrin thrombosis.…”

Section: O P Y R I G H T G E N E R a L P R A C T I C E A I R W A Y mentioning

confidence: 99%

Microscopic pulmonary neoplastic emboli: report of a case with respiratory failure but normal imaging

Chatkin

Fritscher

Fiterman

et al. 2007

Primary Care Respiratory Journal

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Pulmonary tumour embolism (PTE) is not an uncommon cause of respiratory failure in patients with cancer, but it is rarely recognised antemortem.1,2 Although the real frequency is not fully known, it is reported to be present in up to 26% of all cancer autopsies.2 PTE without any significant parenchymal metastases was seen in only 2.4% of cases. 3 We describe the case of a patient presenting with fulminant respiratory failure, with normal initial imaging but progression to death in 72 hours, which was due to pulmonary tumour embolism. Case reportA 42-year-old female presented with progressive dyspnoea of four weeks' duration without any other respiratory symptoms, worsening over the last couple of days. She had had excision of a breast adenocarcinoma three years previously. On admission, she was in respiratory distress (respiratory rate 28/min) with mild cyanosis, and pulse was 110 beats/minute. AbstractPulmonary tumour microembolism is a recognised cause of respiratory failure in patients with cancer, but is frequently under-recognised. We report the case of a 42-year-old female patient admitted because of rapidly progressive severe dyspnoea with a normal chest X-ray (CXR). Initial investigation and imaging was inconclusive, with normal computerised tomography (CT) scans and pulmonary angiotomography. Videothoracoscopic biopsy was performed. Microscopic examination revealed metastatic adenocarcinoma in the lungs, with pulmonary vasculature showing numerous microemboli in small arterioles. The site of origin was consistent with a primary breast adenocarcinoma resected three years previously. Despite treatment in the Intensive Care Unit, the patient died 72 hours after admission. Active consideration and investigation for malignancy should always be considered in the differential diagnosis of patients with severe unexplained dyspnoea.

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Subacute Cor Pulmonale

Cited by 85 publications

References 7 publications

Nonthrombotic pulmonary embolism

Nonthrombotic pulmonary embolism

Adenocarcinoma of the Lung Presenting as Thrombotic Thrombocytopenic Purpura

Microscopic pulmonary neoplastic emboli: report of a case with respiratory failure but normal imaging

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