A Case of Pulmonary Tumor Thrombotic Microangiopathy Differentiated From Acute Pulmonary Thromboembolism

症例は67歳女性．前医で十二指腸異所性胃粘膜由来胃癌，粘液産生胆管癌，多発リンパ節転移と診断され，化学療法を施行されていたが，入院中に胸痛を認め，急性冠症候群の疑いで当院へ救急搬送となった．来院時，低酸素血症があり，心臓超音波検査では右心系の拡大，左室圧排所見，肺高血圧を認めた．急性肺血栓塞栓症を疑い造影CTを施行したが，肺動脈内に明らかな血栓は確認されず，肺換気血流シンチグラフィを施行したところ，両肺野末梢に散在する血流欠損像を認めた．入院第3病日にショック状態となり，急速な経過から臨床的に肺腫瘍源性塞栓性微小血管症（PTTM：pulmonary tumor thrombotic micro...

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Published inShinzo Vol. 53; no. 8; pp. 833 - 839
Main Authors Matsuda, Koji, Endo, Akihiro, Sato, Hirotomo, Tanabe, Kazuaki, Kagawa, Yuzo, Ouchi, Takeshi, Morita, Yusuke, Kawahara, Hiroshi, Watanabe, Nobuhide, Yoshitomi, Hiroyuki, Yamaguchi, Kazuto, Kawanami, Yuka
Format Journal Article
LanguageJapanese
Published Japan Heart Foundation 15.08.2021
公益財団法人 日本心臓財団
Subjects
塞栓
悪性腫瘍
肺腫瘍源性塞栓性微小血管症
肺高血圧
Online AccessGet full text
ISSN0586-4488
2186-3016
DOI10.11281/shinzo.53.833

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Abstract 症例は67歳女性．前医で十二指腸異所性胃粘膜由来胃癌，粘液産生胆管癌，多発リンパ節転移と診断され，化学療法を施行されていたが，入院中に胸痛を認め，急性冠症候群の疑いで当院へ救急搬送となった．来院時，低酸素血症があり，心臓超音波検査では右心系の拡大，左室圧排所見，肺高血圧を認めた．急性肺血栓塞栓症を疑い造影CTを施行したが，肺動脈内に明らかな血栓は確認されず，肺換気血流シンチグラフィを施行したところ，両肺野末梢に散在する血流欠損像を認めた．入院第3病日にショック状態となり，急速な経過から臨床的に肺腫瘍源性塞栓性微小血管症（PTTM：pulmonary tumor thrombotic microangiopathy）と診断，同日永眠された．　担癌患者で肺高血圧を認めたときには，肺血栓塞栓症の他にPTTMを鑑別に挙げ，造影CTで血栓がない場合でも，肺換気血流シンチグラフィなど追加の検査を行う必要がある．
AbstractList 症例は67歳女性．前医で十二指腸異所性胃粘膜由来胃癌，粘液産生胆管癌，多発リンパ節転移と診断され，化学療法を施行されていたが，入院中に胸痛を認め，急性冠症候群の疑いで当院へ救急搬送となった．来院時，低酸素血症があり，心臓超音波検査では右心系の拡大，左室圧排所見，肺高血圧を認めた．急性肺血栓塞栓症を疑い造影CTを施行したが，肺動脈内に明らかな血栓は確認されず，肺換気血流シンチグラフィを施行したところ，両肺野末梢に散在する血流欠損像を認めた．入院第3病日にショック状態となり，急速な経過から臨床的に肺腫瘍源性塞栓性微小血管症（PTTM：pulmonary tumor thrombotic microangiopathy）と診断，同日永眠された．　担癌患者で肺高血圧を認めたときには，肺血栓塞栓症の他にPTTMを鑑別に挙げ，造影CTで血栓がない場合でも，肺換気血流シンチグラフィなど追加の検査を行う必要がある．
Author Ouchi, Takeshi
Watanabe, Nobuhide
Endo, Akihiro
Morita, Yusuke
Kagawa, Yuzo
Sato, Hirotomo
Matsuda, Koji
Yamaguchi, Kazuto
Yoshitomi, Hiroyuki
Kawanami, Yuka
Kawahara, Hiroshi
Tanabe, Kazuaki
Author_FL 遠藤 昭博
吉冨 裕之
森田 祐介
田邊 一明
香川 雄三
松田 紘治
川原 洋
佐藤 寛大
渡邊 伸英
川波 由佳
大内 武
山口 一人
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DocumentTitle_FL 急性肺血栓塞栓症と鑑別を要し肺腫瘍源性塞栓性微小血管症が疑われた1例
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References 7) Higo K, Kubota K, Takeda A, et al：Successful antemortem diagnosis and treatment of pulmonary tumor thrombotic microangiopathy. Intern Med 2014；53：2595-2599
6) Minatsuki S, Miura I, Yao A, et al：Platelet-derived growth factor receptor-tyrosine kinase inhibitor, imatinib, is effective for treating pulmonary hypertension induced by pulmonary tumor thrombotic microangiopathy. Int Heart J 2015；56：245-248
1) Von Herbay A, Illes A, Waldherr R, Otto HF：Pulmonary tumor thrombotic microangiopathy with pulmonary hypertension. Cancer 1990；66：587-592
2) Sato Y, Marutsuka K, Asada Y, et al：Pulmonary tumor thrombotic microangiopathy. Pathol Int 1995；45：436-440
5) Uruga H, Fujii T, Kurosaki A, et al：Pulmonary tumor thrombotic microangiopathy：a clinical analysis of 30 autopsy cases. Intern Med 2013；52：1317-1323
3) Crane R, Rudd TG, Dail D：Tumor microembolism：pulmonary perfusion pattern. J Nucl Med 1984；25：877-880
4) Keenan NG, Nicholson AG, Oldershaw PJ：Fatal acute pulmonary hypertension caused by pulmonary tumour thrombotic microangiopathy. Int J Cardiol 2008；124：e11-e13
References_xml – reference: 2) Sato Y, Marutsuka K, Asada Y, et al：Pulmonary tumor thrombotic microangiopathy. Pathol Int 1995；45：436-440
– reference: 4) Keenan NG, Nicholson AG, Oldershaw PJ：Fatal acute pulmonary hypertension caused by pulmonary tumour thrombotic microangiopathy. Int J Cardiol 2008；124：e11-e13
– reference: 3) Crane R, Rudd TG, Dail D：Tumor microembolism：pulmonary perfusion pattern. J Nucl Med 1984；25：877-880
– reference: 1) Von Herbay A, Illes A, Waldherr R, Otto HF：Pulmonary tumor thrombotic microangiopathy with pulmonary hypertension. Cancer 1990；66：587-592
– reference: 5) Uruga H, Fujii T, Kurosaki A, et al：Pulmonary tumor thrombotic microangiopathy：a clinical analysis of 30 autopsy cases. Intern Med 2013；52：1317-1323
– reference: 7) Higo K, Kubota K, Takeda A, et al：Successful antemortem diagnosis and treatment of pulmonary tumor thrombotic microangiopathy. Intern Med 2014；53：2595-2599
– reference: 6) Minatsuki S, Miura I, Yao A, et al：Platelet-derived growth factor receptor-tyrosine kinase inhibitor, imatinib, is effective for treating pulmonary hypertension induced by pulmonary tumor thrombotic microangiopathy. Int Heart J 2015；56：245-248
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Snippet 症例は67歳女性．前医で十二指腸異所性胃粘膜由来胃癌，粘液産生胆管癌，多発リンパ節転移と診断され，化学療法を施行されていたが，入院中に胸痛を認め，急性冠症候群の...
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SubjectTerms 塞栓
悪性腫瘍
肺腫瘍源性塞栓性微小血管症
肺高血圧
Title A Case of Pulmonary Tumor Thrombotic Microangiopathy Differentiated From Acute Pulmonary Thromboembolism
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