Cardiac and vascular surgery and revascularization: Original articlesPulmonary tumor thrombotic microangiopathy: the challenge of the antemortem diagnosisPatrignani, Anna; Purcaro, Augusto; Calcagnoli, Francesca; Mandolesi, Alessandra; Bearzi, Italo; Ciampani, NinoAuthor Information aCardiology Department, Area Vasta n° 2, Senigallia bCardiology Department cPathology Department, Ospedali Riuniti, Ancona, Italy Correspondence to Dr Anna Patrignani, Cardiology Department, Area Vasta n° 2, Via Cellini n°1, Senigallia, Ancona 60019, ItalyTel: +39 071 79092534; fax: +39 071 79092081; e-mail: [email protected] Received 10 February, 2012 Revised 5 April, 2012 Accepted 16 April, 2012 Journal of Cardiovascular Medicine: November 2014 - Volume 15 - Issue 11 - p 828-833 doi: 10.2459/JCM.0b013e328354e473 Buy Metrics Abstract Pulmonary tumor thrombotic microangiopathy (PTTM) is known as a rare and severe cancer-related pulmonary complication. Nowadays, fewer than 80 cases have been reported in the literature and very few cases have been diagnosed antemortem. We describe an autopsy case of PTTM associated with cancer of unknown origin. A 56-year-old male patient came to our attention due to a 2-day history of dyspnea. Analysis of the clinical context in combination with laboratory and imaging tests led us to suspect acute pulmonary thromboembolism. However, the computed tomography pulmonary angiogram was negative for thromboembolism; on the contrary it revealed multiple lymphadenopathy. Microscopic pulmonary tumor embolism was suspected and a lymph node biopsy was planned. However, the patient's condition progressively worsened; death occurred 3 days after admission. After autopsy, histologically extensive neoplastic emboli involved the small pulmonary arteries and arterioles, often admixed with fibrin thrombi. The involved and noninvolved arteries also demonstrated fibrocellular intimal proliferation causing marked luminal stenosis and occlusion. These pathological features were characteristic of PTTM, which should be distinguished from microscopic tumor embolism and should be considered in the differential diagnosis of acute/subacute cor pulmonale and pulmonary hypertension in cancer as well as in noncancer patients. We propose a review of the literature and an algorithm to improve PTTM antemortem diagnosis. © 2014 Italian Federation of Cardiology. All rights reserved.