The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Advanced Gastric Cancer

진행성 위암에서 동반된 폐동맥 종양 혈전성 미세혈관병증 1예

  • Jun, Ji Eun (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Jung Hoon (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ryu, Duck Hyun (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Ji Eun (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Ho Jung (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang, Jeong Hoon (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 전지은 (성균관대학교 의과대학 내과학교실) ;
  • 김정훈 (성균관대학교 의과대학 내과학교실) ;
  • 유덕현 (성균관대학교 의과대학 내과학교실) ;
  • 이지은 (성균관대학교 의과대학 내과학교실) ;
  • 정호중 (성균관대학교 의과대학 내과학교실) ;
  • 양정훈 (성균관대학교 의과대학 내과학교실)
  • Received : 2013.10.13
  • Accepted : 2014.01.31
  • Published : 2014.11.01
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Abstract

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.

폐동맥 종양 혈전성 미세혈관병증은 폐동맥 고혈압을 유발하고 우심부전으로 진행하여 사망에 이를 수 있는 암과 관련된 호흡기계 합병증이다. 진단을 위한 영상학적 검사들이 있지만 민감도와 특이도가 낮고, 진단 전 급속히 악화되어 사망하므로 부검으로 확인하는 경우가 대부분이다. 저자들은 위암종을 진단받고 위전절제술 및 보조 항암 화학 방사선 치료 후 재발 없이 경과 관찰하다가 급속히 악화되는 운동성 호흡곤란을 주소로 내원한 환자에게서 폐 조직 검사로 진단된 폐동맥 종양 혈전성 미세혈관병증을 경험하여 문헌고찰과 함께 보고하는 바이다.

Keywords

References

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