• Hua Ma, Jian-Mei Gao, Jing Wang, Ling-Yan Huang, Xing-Cang Tian, Zhi-Gang Tian, Shao-Jin Wang, Gang Ma, Hai Tan, and Shu-Xiang Zhang.
• Clinical Medical College, Ningxia Medical University, Yinchuan, China.
• Medicine (Baltimore). 2024 Jun 28; 103 (26): e38618e38618.

RationalePulmonary tumor thrombotic microangiopathy (PTTM) is a rare but serious complication in patients with malignancy; its main manifestation includes acute pulmonary hypertension with severe respiratory distress. More than 200 cases have been reported since it was first identified in 1990. PTTM accounts for approximately 0.9% to 3.3% of deaths due to malignancy, but only a minority of patients are diagnosed ante-mortem, with most patients having a definitive diagnosis after autopsy.Patient ConcernsTwo middle-aged women both died within a short period of time due to progressive dyspnea and severe pulmonary hypertension.DiagnosesOne patient was definitively confirmed as a gastrointestinal malignant tumor by liver puncture biopsy pathology. Ultimately, the clinical diagnosis was pulmonary tumor thrombotic microangiopathy.InterventionsThe patient was treated symptomatically with oxygen, diuresis, and anticoagulation, while a liver puncture was perfected to clarify the cause.OutcomesTwo cases of middle-aged female patients with rapidly progressive pulmonary hypertension and respiratory failure resulted in death with malignant neoplasm.LessonsPTTM has a rapid onset and a high morbidity and mortality rate. Our clinicians need to be more aware of the need for timely diagnosis through a targeted clinical approach, leading to more targeted treatment and a better prognosis.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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