Right-sided cardiogenic shock from acute pulmonary tumor thrombotic microangiopathy: a rare but deadly cardio-oncologic and metabolic emergency

Our data suggest that the combination of elevated hsTnT, NT-proBNP, d-dimer, and HbA1c values in patients with unexplained acute right heart failure may indicate PTTM. Our findings also emphasize the diagnostic challenge posed by PTTM, and imply that targeted therapy, enabled by a timely diagnosis, may improve survival. Therefore, acute and fatal right heart failure in the adult in absence of coronary artery disease, pulmonary embolism, or any other apparent cause, especially in patients with uncontrolled metabolic syndrome, should prompt an urgent diagnostic work-up to rule out unknown cancer with treatable pulmonary tumor embolism, beginning with more extensive imaging (e.g., computed tomography (CT) and magnetic resonance tomography (MRI)), as well as laboratory diagnostics (e.g., tumor markers). In still inconclusive cases, lung biopsy and right heart catheterization should be considered eventually, if possible.