Cas clinique
Hypertension artérielle pulmonaire postembolique tumoralePulmonary arterial hypertension due to tumour emboli

https://doi.org/10.1016/S0761-8425(07)91070-0Get rights and content

Résumé

Introduction

L’hypertension artérielle pulmonaire (HTAP) en contexte néoplasique est une affection rare et plusieurs mécanismes sont envisageables parmi lesquelles les embolies vasculaires pulmonaires néoplasiques.

Observation

Nous rapportons notre expérience de 5 cas cliniques et faisons une revue de la littérature sur les mécanismes physiopathologiques et les attitudes diagnostiques et thérapeutiques envisageables.

Conclusions

L’HTAP néoplasique par micro-embolies tumorales artérielles pulmonaires est rare et son diagnostic est difficile. L’examen cytologique de sang artériel pulmonaire pourrait permettre l’instauration précoce d’une chimiothérapie adaptée susceptible d’apporter une amélioration au pronostic sombre de cette pathologie.

Summary

Introduction

Pulmonary arterial hypertension (PAH) is rare in the presence of malignancy and tumour embolisation is one of several possible pathological mechanisms.

Case reports

We report our experience of 5 clinical cases and undertake a literature revue of the pathophysiological mechanisms and of the possible diagnostic and therapeutic approaches.

Conclusions

Neoplastic PAH due to tumour micro-emboli is rare and the diagnosis difficult to establish. Cytological examination of pulmonary arterial blood could allow early institution of appropriate chemotherapy and lead to an improvement in the grave prognosis of this condition.

Références (39)

  • S.Z. Goldhaber et al.

    Clinical suspicion of autopsy-proven thrombotic and tumor pulmonary embolism in cancer patients

    Am Heart J

    (1987)
  • R.G. Masson et al.

    Pulmonary microvascular cytology. A new diagnostic application of the pulmonary artery catheter

    Chest

    (1985)
  • J.S. Bhuvaneswaran et al.

    Pulmonary wedge aspiration cytology in the diagnosis of recurrent tumour embolism causing pulmonary arterial hypertension

    Int J Cardiol

    (1993)
  • A. Abati et al.

    Diagnosis of pulmonary microvascular metastases by cytologic evaluation of pulmonary artery catheter derived blood specimens

    Hum Pathol

    (1994)
  • J.D. Daughtry et al.

    Pulmonary embolus presenting as the initial manifestation of renal cell carcinoma

    Ann Thorac Surg

    (1977)
  • D. Montani et al.

    Hypertension artérielle pulmonaire

    Rev Mal Respir

    (2005)
  • G. Simonneau et al.

    Clinical classification of pulmonary hypertension

    J Am Coll Cardiol

    (2004)
  • M. Seguchi et al.

    Pulmonary hypertension associated with pulmonary occlusive vasculopathy after allogeneic bone marrow transplantation

    Transplantation

    (2000)
  • K. Shan et al.

    Anthracycline-induced cardiotoxicity

    Ann Intern Med

    (1996)
  • Cited by (16)

    • Pulmonary tumor thrombotic microangiopathy

      2017, Revue des Maladies Respiratoires
    • Pulmonary hypertension associated with chronic hemolytic anemia and other blood disorders

      2013, Clinics in Chest Medicine
      Citation Excerpt :

      In patients with a high thrombotic risk, therapy with hydroxyurea is recommended.124 Precapillary PH mimicking PAH73,110,120,125–137: Several factors have been suggested for the pathogenesis of PAH in patients with CMPD: (1) Portal hypertension, which is a cause of PAH and is a well-known complication of myeloid metaplasia with myelofibrosis.138 ( 2) Chemotherapeutic agents or stem cell transplantation, both of which are treatment options for these conditions and have been associated with pulmonary venoocclusive disease.125 (

    • Classification of Pulmonary Hypertension

      2012, Heart Failure Clinics
      Citation Excerpt :

      Metastatic tumor microemboli are rare but can lead to rapidly progressive and fatal PH. Patients with this condition usually have a history of cancer (typically breast, lung, or gastric carcinomas) and are hypoxic on presentation, with clear lung fields on imaging and no evidence of pulmonary emboli on CT pulmonary angiography. Ventilation-perfusion scanning often shows abnormalities of perfusion, including diffusely heterogeneous perfusion abnormalities without segmental or subsegmental defects or multiple subsegmental ventilation-perfusion mismatches.161,162 Pulmonary microvascular blood aspiration via a pulmonary artery catheter in the wedge position with cytologic analysis for tumor cells can be diagnostic in these cases.

    • Atypical unilateral insterstitial disease

      2011, Revue des Maladies Respiratoires
    • Updated Clinical Classification of Pulmonary Hypertension

      2009, Journal of the American College of Cardiology
      Citation Excerpt :

      Occlusion of the microvasculature by metastatic tumor emboli represents another rare cause of rapidly progressive PH (136). The initial laboratory evaluation shows hypoxemia, often severe, with a clear lung field (137). Computed tomography scanning does not show proximal thrombi but often shows thickening of septa.

    View all citing articles on Scopus
    View full text