Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare complication observed in patients with cancer, causing mainly progressive but sometimes acute pulmonary hypertension. Case summary A patient with a recent transcatheter aortic valve implantation (TAVI) and a localized urothelial carcinoma on the urinary bladder presented with acute pressure overload of the right ventricle which led to refractory shock resulting in death. The initial suspicion was pulmonary thromboembolism but he was finally diagnosed with tumor thrombotic microangiopathy at autopsy. Discussion PTTM can lead to an abrupt clinical picture of respiratory failure and shock, similar to pulmonary thromboembolism (PTE), but with a completely different etiology. Unfortunately, the diagnosis is usually made at autopsies. Take home messages This case illustrates a rare but important cause in the differential diagnosis of acute pressure overload in the right ventricle (RV), especially in patients with known malignancy.
García-Hernando et al. (Tue,) studied this question.