Thrombotic Microangiopathy of Pulmonary Tumors: A Vascular Cause of  Tree-In-Bud Pattern on CT

Franquet, Tomás; Giménez, A.; Prats, Rosa; Rodríguez-Arias, J.M.; Rodriguez, C.

doi:10.2214/ajr.179.4.1790897

Cited by 132 publications

(83 citation statements)

References 8 publications

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“…Diffuse centrilobular nodular and a tree-in-bud pattern on chest CT is caused by the dilation and plugging of small airways by mucus and inflammatory material, which are often seen in patients with small airway disease. This pattern is seen in the present case and also in a few cases with PTTM [8,9]. This pattern might be the sign of a variety of pulmonary vascular abnormalities, including pulmonary tumor embolism and PTTM.…”

Section: Discussionsupporting

confidence: 77%

Pulmonary Tumor Thrombotic Microangiopathy by Lung Adenocarcinoma

Furuno¹,

Tanaka

Ueno³

et al. 2013

JCR

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Abstract:Pulmonary tumor thrombotic microangiopathy, which was established as a disease entity by von Herbay et al, is an uncommon cancer-related complication. The most common disease associated with pulmonary tumor thrombotic microangiopathy is poorly differentiated adenocarcinoma of the stomach, and cancers other than gastric cancers are very rare. We present a case of pulmonary tumor thrombotic microangiopathy caused by lung adenocarcinoma which was found in a 61-year-old Japanese woman. She was taken suffering from general fatigue without any history of cancers. Two-days after admission she suddenly complained of dyspnea and succumbed to pulmonary hypertension. Postmortem autopsy revealed that lung adenocarcinoma with multiple liver metastasis and intimal proliferation of pulmonary small arteries with or without tumor emboli, which were characteristics of pulmonary tumor thrombotic microangiopathy.

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Section: Discussionsupporting

confidence: 77%

Pulmonary Tumor Thrombotic Microangiopathy by Lung Adenocarcinoma

Furuno¹,

Tanaka

Ueno³

et al. 2013

JCR

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“…Centrilobular nodularity on HRCT is an early sign in PTTM, and may disappear following chemotherapy [28], in keeping with resolution of the small vessel lesions. Quite frequently, the centrilobular nodules exhibit a tree in bud nodular pattern, a feature usually associated with plugging of respiratory bronchioles rather than vascular disease [33].…”

Section: Main Hrct Findingsmentioning

confidence: 99%

Pulmonary tumour thrombotic microangiopathy

Price

Wells

Wort

2016

Current Opinion in Pulmonary Medicine

120

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Purpose of review Pulmonary tumour thrombotic microangiopathy (PTTM) describes tumour cell microemboli with occlusive fibrointimal remodelling in small pulmonary arteries, veins and lymphatics. Progressive vessel occlusion ultimately results in pulmonary hypertension, which is often severe and rapid in onset. PTTM is associated with carcinomas, notably gastric carcinoma, with vascular endothelial growth factor and platelet-derived growth factor signalling implicated in driving the intimal remodelling. PTTM is a rare cause of pulmonary hypertension, but given that up to a quarter of autopsy specimens from patients dying of carcinoma show evidence for PTTM, it is probably underdiagnosed AQ5 . Recent findingsUntil recently, prognosis in PTTM was universally abysmal from weeks to a few months. Diagnostic utilities include aspiration of tumour cells at wedged right heart catheterization, HRCT AQ6 findings and computed tomography-positron emission tomography (CT-PET), although definitive diagnosis requires histological analysis. Reports of PTTM treated with a combination of targeted pulmonary vasodilator therapies, anticoagulation, specific chemotherapy and platelet-derived growth factor inhibition, for example using imatinib, suggest that these approaches can prolong survival.Summary PTTM is increasingly recognized as an important cause of pulmonary hypertension, often in patients presenting with new-onset pulmonary hypertension and as yet undiagnosed malignancy. Prospects of survival are improving with targeted combination therapy, and early recognition and diagnosis are likely to be the key factors to improve outcome.

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“…However, a few reports showed characteristic tree-in-bud upon chest CT [10]. In some cases, aggressive bronchoscopic biopsy, transbronchial lung biopsy, and pulmonary microvascular cytology using a wedged pulmonary artery catheter have been suggested for diagnosis of PTTM [5,6,8,11].…”

Section: Discussionmentioning

confidence: 99%