Usefulness of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for the Diagnosis of Pulmonary Tumor Thrombotic Microangiopathy

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  • 微小な胃癌が原因となったpulmonary tumor thrombotic microangiopathyに対してEBUS-TBNAの有用性が示唆された1例

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Abstract

<p>Background. Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and serious complication of cancer, characterized by rapidly progressive respiratory failure and pulmonary hypertension. Its early diagnosis is essential for reducing the risk of mortality with this fatal disease. However, the antemortem diagnosis of PTTM is challenging during its rapid progressive clinical course, especially in patients without a previous diagnosis of cancer. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method of performing a hilar/mediastinal biopsy to obtain samples. We obtained adequate metastatic lymph node tissue using EBUS-TBNA adequately in a patient with PTTM. Case. A 43-year-old man complained of hemoptysis and dyspnea. Respiratory failure with pulmonary hypertension rapidly progressed. Chest X-ray showed right hilar lymph node enlargement. EBUS-TBNA was performed without any complications. He died from respiratory failure on the fifth hospital days. An autopsy revealed PTTM and a small gastric cancer lesion. EBUS-TBNA also revealed signet ring-cell carcinoma in the mediastinal lymph node tissue. Conclusion. EBUS-TBNA may be suitable for inclusion as a conventional diagnostic modality in patients suspected of having PTTM with hilar/mediastinal lymphadenopathy.</p>

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