Pulmonary tumor thrombotic microangiopathy: A case report and literature review

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare malignancy-associated condition characterized by progressively worsening dyspnea, dry cough, hypoxemia, pulmonary hypertension, right-sided heart failure, and sudden death. A 60-year-old female presented with intermittent dry cough, dyspnea, and chest pain. The patient was suspected of having PTTM with a pancreatic primary malignancy, based on admission findings including percutaneous oxygen saturation of 88%, respiratory alkalosis on blood-gas analysis, and elevated levels of d-dimer, NT-proBNP, and multiple tumor markers, combined with computed tomography angiography results showing enlarged lymph nodes (mediastinum, bilateral hila, right cardiophrenic angle, retroperitoneum) and a blurred peripancreatic space. Diagnostic investigations included physical examination, blood-gas analysis, laboratory tests (d-dimer, NT-proBNP, tumor markers), and computed tomography angiography of thoracic/abdominal vessels. (No therapeutic interventions detailed). The patient experienced 4 episodes of sudden clinical deterioration, suffered cardiac arrest, and died 9 days after admission. Autopsy was declined by the family. PTTM must be considered in the differential diagnosis for patients presenting with dyspnea and new-onset severe pulmonary hypertension without other obvious etiology, particularly when malignancy is suspected.