title: Subacute right heart failure revealing three simultaneous causes of post-embolic pulmonary hypertension in metastatic dissemination of breast cancer.
abstract: A 72-year-old woman with history of breast cancer only treated surgically was referred to our department for pulmonary hypertension (PH) suspicion. Echocardiogram revealed elevated right ventricular systolic pressure. Computed tomography (CT) angiogram showed no pulmonary embolism (PE), but lung scan revealed two ventilation-perfusion mismatch areas. Right cardiac catheterization established precapillary PH. Despite treatment with PH specific therapy (sildenafil, ambrisentan, and epoprostenol), her condition worsened rapidly with acute right heart failure (RHF). She died 22 days after admission. Post-mortem microscopic examination showed a rare combination of PH etiologies consistent with metastasis of breast cancer in pulmonary vasculature including the rare pulmonary tumour thrombotic microangiopathy (PTTM).
authors.affiliation: Centre Hospitalier Universitaire de Lille Institut coeur-poumon, Clinique de cardiologie Lille France.
authors.forename: Flavien
authors.initials: F
authors.lastname: Vincent
authors.affiliation: Centre Hospitalier Universitaire de Lille Institut coeur-poumon, Clinique de cardiologie Lille France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.affiliation: Anatomie et Cytologie Pathologiques CHU Lariboisière Paris France.
authors.forename: Marion
authors.initials: M
authors.lastname: Classe
authors.affiliation: Centre Hospitalier Universitaire de Lille Institut coeur-poumon, Clinique de cardiologie Lille France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Schurtz
authors.affiliation: Centre Hospitalier Universitaire de Lille Service d'hématologie et de transfusion Lille France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rauch
authors.affiliation: Centre Hospitalier Universitaire de Lille Institut coeur-poumon, Clinique de cardiologie Lille France.
authors.forename: Marie
authors.initials: M
authors.lastname: Fertin
authors.affiliation: Centre Hospitalier Universitaire de Lille Institut coeur-poumon, Clinique de cardiologie Lille France.
authors.forename: Pascal
authors.initials: P
authors.lastname: De Groote
keywords: Carcinomatosis lymphangitis; Cardiogenic shock; Death; Dyspnea; Pulmonary embolism; Pulmonary hypertension; Pulmonary tumor thrombotic microangiopathy; Right heart failure; Tumor cell embolic