Pulmonary tumor thrombotic microangiopathy associated with gastric cancer diagnosed during life

Abstract

A 69-year-old man presented with dyspnea on exertion, persisting for 1 month. Pulmonary thromboembolism was suspected, but enhanced CT and lung perfusion imaging showed no evidence of pulmonary artery thromboembolism. There was swelling of the paragastric and para-aortic lymph nodes, and gastric cancer was diagnosed on upper gastrointestinal endoscopy. We performed right cardiac catheterization and withdrew some blood from a pulmonary artery catheter in the wedge position. We confirmed the presence of adenocarcinoma malignant cells in the aspirated blood. Pulmonary tumor thrombotic microangiopathy (PTTM) associated with gastric cancer was diagnosed. The patient received noninvasive positive-pressure ventilation, and the symptoms improved. He was then given an anticancer drug (S-1) for 3 months on an outpatient basis. Exertional dyspnea developed, and the patient was admitted to the emergency department of our hospital. He died of respiratory failure on hospital day 1. To the best of our knowledge, preterminal diagnosis of PTTM has rarely been reported in Japan.