Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Metastatic Gastric Cancer

History and clinical findings A 53-year-old woman with relapsed metastatic gastric cancer after multimodal therapy was hospitalized 6 months after the end of treatment due to acute dyspnea. Investigations and diagnosis The examination showed tachycardia and tachypnea. D-dimers and LDH were elevated, blood gases were still in the standard range. In the CT we could exclude a pulmonary embolism (LE) and pneumonia. The echocardiography (EC) showed no abnormalities. A new malignant pleural effusion on the left was detected. Diagnosis The diagnosis of pulmonary tumor thrombotic microangiopathy (PTTM) in the context of relapsed metastatic gastric cancer was confirmed. Treatment and course The patient developed progressive respiratory failure and had to be moved to the intensive care unit. In the EC we discovered a progressive right ventricular heart failure. With the suspicion of a severe LE and vital indication we started a thrombolysis, but it remained unsuccessful. The CT showed changes consistent with a PTTM. The patient died a few days later. Conclusion PTTM is a rare and often fatal tumor-associated pulmonary complication.