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Case Reports 2018

Medical Case Reports

ISSN: 2471-8041

Page 40

May 28-29, 2018

London, UK

Edition of International Conference on

Clinical and Medical Case Reports

e report the caseof a56 year old, previously fit andwell lady

who presented with a three week history of progressive

shortness of breath. She had previously received treatment for

breast cancer in 2013 and routine surveillance had not shown

any evidence of disease recurrence. A pulmonary embolism

was suspected on admission, though CTPA was negative. The

report made note of an enlarged and irregular liver of uncertain

aetiology. These findings were discussed with hepatology

and radiology teams who felt it did not signify malignancy.

The patient’s oxygen requirements continued to rise and

transthoracic echocardiography showed marked right heart

dilatation with significant pulmonary hypertension. A CA 15-3

blood test was elevated at 8677, raising suspicion of breast

cancer recurrence with extensive pulmonary involvement. The

patient continued to deteriorate and passed away six days

after admission. A hospital post-mortem did not show tumour

recurrence in the breast tissue or chest wall. Histological

examination of the liver showed extensive areas of poorly

preserved tumour infiltrate and necrosis, whilst analysis of

lung tissue revealed discohesive cells within small pulmonary

vessels. The findings of the post-mortem are consistent with

a diagnosis of pulmonary tumour thrombotic microangiopathy

(PTTM). This illustrates a rare presentation of PTTM, which is

difficult to diagnose, treat and is time critical, with post mortem

results that do not show recurrence of tumour in local tissue.

Despite its rarity, PTTM should be considered in patients who

present with acute shortness of breath on a background of

previous breast cancer.

Biography

Owain Thomas is currently affiliated with the Warkwick Hospital, run by

South Warwickshire NHS Foundation Trust

Pulmonary tumour thrombotic microangiopathy: an important

consideration for patients with a history of breast cancer

Owain Thomas

and

Jonathan Senior

Warwick Hospital, UK

Owain Thomas et al., Med Case Rep. 2018, Volume 4

DOI:10.21767/2471-8041-C1-002