Pulmonary Tumor Thrombotic Microangiopathy Diagnosed during the Postoperative Course of Breast Cancer—A Case Report—

Abstract

A 68-year-old woman underwent partial mastectomy for right breast cancer (T2N0M0 Stage IIA). She developed sudden onset of dyspnea on exertion, 7 years postoperatively. This symptom gradually progressed, and the patient had difficulty moving, which necessitated a visit to our hospital. Contrast-enhanced chest computed tomography revealed no obvious organic disease. Echocardiography revealed right heart load, and lung perfusion scintigraphy revealed multiple wedge-shaped defects in the lung periphery bilaterally. Pulmonary artery aspiration cytology revealed atypical cells. Based on her medical history, clinical symptoms, and cytology findings, the patient was diagnosed with pulmonary tumor thrombotic microangiopathy (PTTM) associated with recurrent breast cancer. Anticoagulant therapy and cardiopulmonary management were continued ; however, the patient's general condition rapidly deteriorated, and she died on the fourth day after admission. PTTM results in rapidly progressive respiratory failure and is therefore associated with poor prognosis. Clinicians should consider PTTM in patients with cancer who develop sudden-onset dyspnea and right heart failure ; early diagnosis and prompt intervention are essential in such cases.