Yeungnam Univ J Med.  2020 Apr;37(2):122-127. 10.12701/yujm.2019.00332.

Fatal progressive right heart failure in a pancreatic cancer patient

• Byoun JT
• Cho JY

• KMID: 2501419
• DOI: http://doi.org/10.12701/yujm.2019.00332

Abstract

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but fatal complication of cancer and causes pulmonary hypertension and acute/subacute right heart failure. PTTM is most commonly associated with gastric cancer and more rarely associated with pancreatic cancer. We report a case of progressive right heart failure associated with clinically diagnosed pancreatic cancer, suggesting PTTM.

Keyword

Pancreatic cancer; Pulmonary hypertension; Right sided heart failure; Thrombotic microangiopathy

Figure

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  Fig. 1. Transthoracic echocardiography. (A) Parasternal short-axis view shows LV systolic septal flattening (arrow) with RV enlargement. (B) Apical 4 chamber view with color Doppler of the tricuspid valve shows RV enlargement (arrow) and moderate tricuspid regurgitation (arrowhead). LV, left ventricle; RV, right ventricle.

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  Fig. 2. Contrast-enhanced CT. (A) Chest CT (lung window) with centrilobular nodules with “tree-in-bud” sign (arrows). (B) Chest CT (mediastinal window) with pleural-enhancing nodules (arrowhead). (C) Abdominopelvic CT show upstream pancreatic duct dilatation (arrow). (D) Abdominopelvic CT with pancreatic head neoplasm (arrowhead). CT, computed tomography.

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  Fig. 3. Ventilation/perfusion lung scan. Anterior view (A) and posterior view (B) of ventilation lung scan present no significant decreased ventilation activity. Anterior view (C) and posterior view (D) of perfusion lung scan show multifocal peripherally distributed small perfusion defects in bilateral lung fields (arrows).

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  Fig. 4. 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography integrated with computed tomography. Maximum intensity projection image (A) and fusion axial views (B, C) show a hypermetabolic mass at the pancreatic head and neck region (arrow) with systemic lymph nodes, bilateral lung and both pleural metastases (arrowhead).

Reference

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