Pulmonary tumor thrombotic microangiopathy (PTTM) is an uncommon and fatal malignancy-related pulmonary complication characterized by fibrocellular intimal proliferation of small pulmonary arteries and arterioles. It causes marked pulmonary hypertension, right-side heart failure, and sudden death. Diagnosis of PTTM is extremely difficult while the patient is alive. Here, we report a 44-year-old woman who presented with complaining of progressing dyspnea and pulmonary hypertension but with no history of cancer. She was diagnosed with PTTM caused by advanced gastric cancer ante mortem and was treated effectively with chemotherapy.

Citations

Citations to this article as recorded by  

• Pulmonary Tumor Thrombotic Microangiopathy Associated With Gastric Cancer: Clinical Characteristics and Outcomes
  Tae-Se Kim, Soomin Ahn, Sung-A Chang, Sung Hee Lim, Byung-Hoon Min, Yang Won Min, Hyuk Lee, Poong-Lyul Rhee, Jae J. Kim, Jun Haeng Lee
  Journal of Gastric Cancer.2025;[Epub]     CrossRef
• Sudden Development of Fatal Pulmonary due to Suspected Pulmonary Tumoral Thrombotic Microangiopathy among Patients with Cancer: Case Series of Clinical and CT Features in 10 Patients
  Bo Kyung Kim, Yookyung Kim, Kyung Eun Lee
  Journal of the Korean Society of Radiology.2024; 85(6): 1169.     CrossRef

Most pulmonary thromboemboli arise from the deep vein thrombosis, which have complete clinical and at least near complete roentgenographic and angiographic resolution within four to six week of the acute event.

But chronic pulmonary hypertension and cor pulmonale from unresolved pulmonary embolism complicate acute embolic episode with a frequency of less than 1 percent. Rarely pulmonary thromboemboli can result from right atrial thrombi.

We experienced a case of chronic thromoboembolic pulmonary hypertension, which wrose from right atrial thrombi in the patient with rheumatic valvaular heart disease and thoracic aorta atherosclerotics stenosis.