Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report

Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to presence microscopic emboli peripheral arteries. Here, we report case rapidly exacerbating PTTM associated with gastric cancer was identified postmortem through pathological autopsy. Case presentation A 52-year-old Asian woman who experienced anterior chest pain while coughing visited orthopedic department Gifu University Hospital. She diagnosed as having multiple osteolytic bone metastases throughout her body and subsequently scheduled undergo combined positron emission tomography computed (CT) search for primary lesion. However, 4 days after visit department, she unable stand up thus emergency department. At time admission, physical examination results revealed had percutaneous oxygen saturation level 90% (on room air) cyanosis in state hemodynamic shock. Laboratory test elevated levels fibrin degradation products D-dimer blood. Chest CT were normal. admitted hospital’s general ward follow-up but soon entered gradually worsening shock respiratory failure. Electrocardiography findings right heart strain; however, contrast-enhanced did not reveal embolism. intensive care unit treated hypertension; 45 h arrival at hospital, died autopsy cancer, microemboli, fibrous intimal thickening arteries both lungs; thus, diagnosis made. Conclusions In patients carcinoma unknown site embolism ruled out by CT, physicians intensivists must consider possibility PTTM, which represents an oncologic emergency, initiate chemotherapy administration possible.