[Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Metastatic Gastric Cancer].

HISTORY AND CLINICAL FINDINGS: A 53-year-old woman with relapsed metastatic gastric cancer after multimodal therapy was hospitalized 6 months after the end of treatment due to acute dyspnea.

INVESTIGATIONS AND DIAGNOSIS: The examination showed tachycardia and tachypnea. D-dimers and LDH were elevated, blood gases were still in the standard range. In the CT we could exclude a pulmonary embolism (LE) and pneumonia. The echocardiography (EC) showed no abnormalities. A new malignant pleural effusion on the left was detected.

DIAGNOSIS: The diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM) in the context of relapsed metastatic gastric cancer was confirmed.

TREATMENT AND COURSE: The patient developed progressive respiratory failure and had to be moved to the intensive care unit. In the EC we discovered a progressive right ventricular heart failure. With the suspicion of a severe LE and vital indication we started a thrombolysis, but it remained unsuccessful. The CT showed changes consistent with a PTTM. The patient died a few days later.

CONCLUSION

PTTM is a rare and often fatal tumor-associated pulmonary complication.