Pulmonary Tumor Thrombotic Microangiopathy With Biventricular Heart Failure.

BACKGROUND

Pulmonary tumor thrombotic microangiopathy (PTTM), a rare and often fatal condition characterized by tumor cell embolization within pulmonary arterioles, is frequently diagnosed using pulmonary artery aspiration cytology. PTTM is associated with poor prognosis.

CASE SUMMARY: A 51-year-old woman with ovarian cancer presented with biventricular heart failure and reduced left ventricular ejection fraction. Right heart catheterization showed a mean pulmonary artery pressure of 34 mm Hg, consistent with combined pre- and postcapillary pulmonary hypertension. Despite these findings, pulmonary artery aspiration cytology confirmed the diagnosis of PTTM. The patient showed clinical improvement after heart failure management and chemotherapy.

DISCUSSION: This case highlights the potential for underdiagnosing PTTM in patients with malignancies in whom pulmonary hypertension appears to be attributable to heart failure. The clinical relevance and diagnostic considerations of PTTM in such cases warrant further investigation.

TAKE-HOME MESSAGE: PTTM with mild or atypical hemodynamic manifestations may be under-recognized in clinical practice.