Pulmonary Tumor Thrombotic Microangiopathy Mimicking Inhalation Lung Injury

Area of Science:

• Pulmonary Medicine
• Oncology
• Pathology

Background:

• Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare vascular complication of malignancy.
• PTTM presents with dyspnea and pulmonary hypertension, often mimicking other diffuse lung diseases.
• Early diagnosis is challenging due to its nonspecific clinical and radiological features.

Observation:

• A patient presented with symptoms suggestive of chemical inhalation lung injury, including dyspnea.
• Chest CT revealed abnormalities mimicking acute lung injury.
• The patient had a history of chemical herbicide inhalation.

Findings:

• Transbronchial lung biopsy diagnosed PTTM with adenocarcinoma.
• Autopsy revealed primary gastric cancer as the underlying cause of PTTM.
• PTTM presentation can closely resemble diffuse pulmonary diseases, including chemical inhalation injury.

Implications:

• This case underscores the importance of considering PTTM in patients with unexplained pulmonary symptoms and imaging findings.
• Histopathological examination of biopsy specimens is critical for accurate diagnosis and differentiating PTTM from other lung conditions.
• Timely diagnosis and treatment, including chemotherapy and anticoagulation, may offer survival benefits, though prognosis remains guarded.