Article Text
Summary
We report the case of a previously healthy man who presented with subacute dyspnoea after a long drive. He developed hypoxic respiratory failure, thought secondary to a massive pulmonary embolism and was treated with tissue plasminogen activator but died in the hospital despite aggressive medical measures. Autopsy revealed pulmonary tumour thrombotic microangiopathy (PTTM) from papillary renal cell carcinoma. PTTM is a rare clinicopathological syndrome that clinically results in symptoms of dyspnoea and right heart failure. Pathologically, a localised paraneoplastic process evolves from tumour microemboli in the pulmonary arterioles, resulting in fibrocellular proliferation and narrowing of the vessels, causing subacute right heart failure. To our knowledge, this is the first case of PTTM due to papillary renal cell carcinoma.
- Adult Intensive Care
- Urological Cancer
- Pulmonary Hypertension
- Heart Failure
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Footnotes
Contributors MS took care of the patient, developed the idea for the case report, researched PTTM and wrote the majority of the manuscript. SK performed the autopsy, researched PTTM and wrote the pathology portion of the manuscript. RR assisted with the diagnosis of PTTM based on gross and pathological autopsy findings and reviewed/edited the pathology portion of the manuscript. SF assisted with manuscript preparation, editing and reviewed the manuscript for content and accuracy.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.