CTICasesPulmonary Tumor Thrombotic Microangiopathy in Prostate Cancer
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Imaging findings
A patient with metastatic prostate cancer presented with severe pulmonary hypertension. CT showed right ventricular and right atrial enlargement with straightening of the interventricular septum. A ventilation-perfusion (V/Q) scan revealed multiple small perfusion defects in a distinctive 'segmental contour pattern,' distinct from the peripheral, wedge-shaped defects typical of ordinary pulmonary embolism.
Key takeaways
This pattern, in the context of malignancy and pulmonary hypertension, is suggestive of pulmonary tumor thrombotic microangiopathy (PTTM) — extensive tumor embolization to small pulmonary vessels with reactive fibrocellular intimal proliferation, causing severe and often relentless pulmonary hypertension with a poor prognosis. The patient died shortly after this presentation.
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See all cases from October 4, 2015 →