A63-43 Severe Pulmonary Hypertension as the First Sign of Occult GI Adenocarcinoma: A Case of Pulmonary Tumor Thrombotic Microangiopathy
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and often fatal cause of rapidly progressive pulmonary hypertension, typically associated with gastrointestinal malignancies. We report the case of a 72-year-old man with a history of diabetes and hyperlipidemia who presented with subacute exertional dyspnea, fatigue, and significant weight loss. Imaging and right heart catheterization revealed severe precapillary pulmonary hypertension, and further workup confirmed metastatic adenocarcinoma, presumed gastrointestinal in origin. He was diagnosed with PTTM based on clinical, radiographic, and histopathologic findings. Treatment with systemic chemotherapy, tadalafil, and off-label imatinib led to improved symptoms, reduced oxygen requirements, and partial echocardiographic recovery. This case highlights the importance of recognizing PTTM as a potential cause of pulmonary hypertension in patients with occult malignancy, and suggests that early, targeted intervention may offer temporary stabilization in selected patients.
This abstract is funded by: None
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