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Open Access Case report

Diffuse bronchiolitis pattern on a computed tomography scan as a presentation of pulmonary tumor thrombotic microangiopathy: a case report

Marcos Duarte Guimarães1*, Maria Fernanda Arruda Almeida1, André Brelinger1, Paula Nicole Barbosa1, Rubens Chojniak1 and Jefferson Luiz Gross2

Author Affiliations

1 Department of Imaging, Hospital AC Camargo, São Paulo/SP, Brazil

2 Department of Thoracic Surgery, Hospital AC Camargo, São Paulo/SP, Brazil

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Journal of Medical Case Reports 2011, 5:575  doi:10.1186/1752-1947-5-575

Published: 12 December 2011

Abstract

Introduction

Pulmonary tumor thrombotic microangiopathy is a rare complication of malignant diseases. The diagnosis is extremely difficult and is most often performed after death. Invariably, patients develop acute pulmonary hypertension causing right heart failure, shortness of breath and death in a few days. We describe the clinical and radiological findings of a patient who presented with this complication.

Case presentation

A 28-year-old Caucasian woman with a previous history of pelvic tumor resection two months previously, suggestive of metastatic adenocarcinoma, presented with intense shortness of breath. A computed tomography scan showed signs of acute cor pulmonale and diffuse nodular opacities associated with a tree-in-bud pattern disseminated through her lungs, suggestive of bronchiolitis. Our patient's condition worsened and she underwent a surgical biopsy. Pathologic analysis of the biopsied specimens revealed pulmonary tumor thrombotic microangiopathy. Our patient's tumor evolved from a gastric origin (Krukenberg tumor). She underwent progressive clinical deterioration and died less than 24 hours after the biopsy. None of the cases described previously in the literature had diffuse centrilobular nodular opacities associated with a tree-in-bud pattern disseminated through the lungs, as in our case.

Conclusion

Pulmonary tumor thrombotic microangiopathy should be considered in cancer patients with rapidly progressing dyspnea, chest computed tomography findings compatible with pulmonary hypertension and typical findings of inflammatory bronchiolitis.