CTICasesPulmonary Tumor Thrombotic Microangiopathy in Metastatic Breast Cancer
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Imaging findings
A second patient with metastatic breast cancer and pulmonary hypertension showed similarly enlarged right heart chambers with septal straightening on CT. CTPA (rather than a V/Q scan) demonstrated a mosaic attenuation pattern with patchy areas of relative hypo- and hyperperfusion of the pulmonary vasculature, along with small nodules possibly representing intravascular tumor.
Key takeaways
Mosaic attenuation on CTPA can be the CT correlate of the perfusion defects seen with pulmonary tumor thrombotic microangiopathy on V/Q scanning, reflecting the same underlying pathology of tumor emboli plus fibrocellular intimal proliferation in small pulmonary vessels. This patient also died soon after presentation, reinforcing PTTM's grave prognosis.
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See all cases from October 4, 2015 →