Pulmonale tumorthrombotische Mikroangiopathie bei einer Patientin mit metastasierendem Magenkarzinom

Zusammenfassung

Anamnese und klinischer Befund Eine 53-jährige Patientin mit einem Rezidiv eines multimodal vorbehandelten Magenkarzinoms musste 6 Monate nach Therapieabschluss mit akuter Atemnot stationär aufgenommen werden.

Untersuchungen Tachykardie und Tachypnoe lagen vor. D-Dimere und LDH waren erhöht, die Blutgase noch unauffällig. In der Computertomografie (CT) konnte eine Lungenarterienembolie (LAE) und eine Pneumonie ausgeschlossen werden. Die Echokardiografie blieb unauffällig. Neu nachweisbar war ein maligner Pleuraerguss links.

Diagnose Im Verlauf bestätigte sich die Diagnose einer pulmonalen tumorthrombotischen Mikroangiopathie (PTTM) im Rahmen eines Magenkarzinomrezidivs.

Therapie und Verlauf Wegen einer progredienten respiratorischen Insuffizienz musste die Patientin auf die Intensivtherapiestation verlegt werden. Echokardiografisch zeigte sich eine neu aufgetretene, ausgeprägte Rechtsherzbelastung. Unter dem Verdacht auf eine fulminante LAE erfolgte aus vitaler Indikation eine Lysetherapie ohne klinischen Erfolg. Die CT zeigte Veränderungen, die mit einer PTTM vereinbar waren. Die Patientin starb nach wenigen Tagen.

Folgerung Die PTTM ist eine seltene tumorassoziierte pulmonale Komplikation mit häufig fatalem Verlauf.

Abstract

History and clinical findings A 53-year-old woman with relapsed metastatic gastric cancer after multimodal therapy was hospitalized 6 months after the end of treatment due to acute dyspnea.

Investigations and diagnosis The examination showed tachycardia and tachypnea. D-dimers and LDH were elevated, blood gases were still in the standard range. In the CT we could exclude a pulmonary embolism (LE) and pneumonia. The echocardiography (EC) showed no abnormalities. A new malignant pleural effusion on the left was detected.

Diagnosis The diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM) in the context of relapsed metastatic gastric cancer was confirmed.

Treatment and course The patient developed progressive respiratory failure and had to be moved to the intensive care unit. In the EC we discovered a progressive right ventricular heart failure. With the suspicion of a severe LE and vital indication we started a thrombolysis, but it remained unsuccessful. The CT showed changes consistent with a PTTM. The patient died a few days later.

Conclusion PTTM is a rare and often fatal tumor-associated pulmonary complication.

Schlüsselwörter

Pulmonale tumorthrombotische Mikroangiopathie PTTM - pulmonale Hypertonie - Tumorzellembolisation - Magenkarzinom - Dyspnoe

Key words

pulmonary tumor thrombotic microangiopathy PTTM - pulmonary hypertension - tumor cell embolism - gastric adenocarcinoma - progressive dyspnea

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