Pulmonary tumor thrombotic microangiopathy from metastatic gallbladder carcinoma: an unusual cause of severe pulmonary hypertension.

Pulmonary hypertension and cor pulmonale due to tumor emboli causing pulmonary tumor thrombotic microangiopathy (PTTM) is rare and extremely difficult diagnosis to make prior to death. Pulmonary hypertension due to metastatic tumor emboli should be included in the differential diagnosis of various causes of dyspnea in patients with a history of cancer or more common causes, including infection, thromboembolism, metastasis, adverse effects of drugs, and recurrent effusions. We describe a patient with gallbladder carcinoma who presented with progressive dyspnea and severe pulmonary hypertension.