Pulmonary Tumor Thrombotic Microangiopathy With Biventricular Heart Failure

Figures

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  Visual Summary. Key Echocardiographic and Cytological Findings During the Clinical Course At the time of admission, the patient's body weight was 65.5 kg. Echocardiography revealed an LVEF of 33% and a TRPG of 36.7 mm Hg. On hospital day 4, right heart catheterization and pulmonary artery aspiration cytology were performed, leading to a subsequent diagnosis of pulmonary tumor thrombotic microangiopathy. The patient was discharged on hospital day 29 weighing 49.6 kg. Follow-up echocardiography on day 85 showed an improvement in LVEF to 48% and TRPG to 19.2 mm Hg, indicating a favorable outcome. LVEF = left ventricular ejection fraction; PAC = pulmonary artery aspiration cytology; RHC = right heart catheterization; TRPG = tricuspid regurgitation pressure gradient.

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  Figure 1. CT Findings Before and After Surgery for Ovarian Cancer (A) Sagittal noncontrast CT imaging before surgery for ovarian cancer. (B) Coronal noncontrast CT imaging before surgery for ovarian cancer. (C) Axial contrast-enhanced CT imaging before surgery for ovarian cancer. (D) Axial contrast-enhanced CT imaging after surgery for ovarian cancer. As indicated by the red arrow in (C), right ventricular enlargement was observed before surgery for ovarian cancer. CT = computed tomography.

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  Figure 2. Echocardiogram and Pulmonary Perfusion Scan Findings (A) Echocardiogram at admission (LV ejection fraction 33%, LV end-diastolic volume/end-systolic volume 163/110 mL, mid–right ventricular diameter 41.7 mm, tricuspid regurgitation pressure gradient 36.7 mm Hg). (B) Pulmonary perfusion scan (diffuse hypoperfusion in the peripheral lung fields). LV = left ventricular.

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  Figure 3. Contrast-Enhanced Magnetic Resonance Imaging Findings As indicated by the red arrow, late gadolinium enhancement is present in the midmyocardium of the left ventricle.

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  Figure 4. Pathologic Findings of Pulmonary Artery Aspiration Cytology Clusters of epithelial cells suspicious for adenocarcinoma were identified on Papanicolaou stain.

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  Figure 5. Clinical Course The clinical course of this patient is summarized as indicated. ACE = angiotensin-converting enzyme; MRA = magnetic resonance angiography; PAC = pulmonary artery aspiration cytology; RHC = right heart catheterization; SGLT2 = sodium-glucose cotransporter 2; TRPG = tricuspid regurgitation pressure gradient.