{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:50:08Z","timestamp":1791903008222,"version":"4.3.4"},"reference-count":10,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare cause of acute cor pulmonale, typically associated with advanced solid tumors; its occurrence as the initial presentation of multiple myeloma (MM) has not been described. A 45\u2010year\u2010old woman developed acute right heart failure on postoperative day 1 after uterine myomectomy. Echocardiography showed a pulmonary artery systolic pressure of 86\u2009mmHg with a\n                    <jats:sc>D<\/jats:sc>\n                    \u2010shaped left ventricle and right ventricular dysfunction (TAPSE 10\u2009mm); CTPA excluded pulmonary embolism but revealed bilateral ground\u2010glass opacities. Platelet count fell from 115\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L preoperatively to 30\u2009\u00d7\u200910\n                    <jats:sup>9<\/jats:sup>\n                    \/L. An overlooked preoperative globulin of 67\u2009g\/L prompted serum protein electrophoresis and immunofixation, which identified an IgG \u03ba M\u2010protein; bone marrow aspiration revealed 14% morphologically abnormal plasma cells. Presumed MM\u2010associated PTTM was treated with heparin and sildenafil. The platelet count recovered, and a follow\u2010up echocardiogram on day 7 showed normalized cardiac structure and function. The patient self\u2010discontinued rivaroxaban 1 week after discharge and died 3 months later from progression of untreated MM. In CTPA\u2010negative acute cor pulmonale with unexplained thrombocytopenia, an elevated globulin on routine biochemistry may be the only early clue to a plasma cell disorder, and timely anticoagulation with pulmonary vasodilation may buy time for definitive therapy.\n                  <\/jats:p>","DOI":"10.1002\/pul2.70425","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:25:55Z","timestamp":1791901555000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute Cor Pulmonale Caused by Pulmonary Tumor Thrombotic Microangiopathy as the Initial Presentation of Multiple Myeloma: A Case Report"],"prefix":"10.1002","volume":"16","author":[{"given":"Jianwei","family":"Cui","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine Liangxiang Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingzhen","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Liangxiang Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9267-2899","authenticated-orcid":false,"given":"Xin","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"12","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.2169\/internalmedicine.52.9472","article-title":"Pulmonary Tumor Thrombotic Microangiopathy: A Clinical Analysis of 30 Autopsy Cases","volume":"52","author":"Uruga H.","year":"2013","journal-title":"Internal Medicine"},{"issue":"3","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1002\/1097-0142(19900801)66:3<587::AID-CNCR2820660330>3.0.CO;2-J","article-title":"Pulmonary Tumor Thrombotic Microangiopathy With Pulmonary Hypertension","volume":"66","author":"Herbay A.","year":"1990","journal-title":"Cancer"},{"issue":"5","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/MCP.0000000000000297","article-title":"Pulmonary Tumour Thrombotic Microangiopathy","volume":"22","author":"Price L. C.","year":"2016","journal-title":"Current Opinion in Pulmonary Medicine"},{"issue":"4","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"e157","DOI":"10.1016\/S2352-3026(17)30026-1","article-title":"Derivation and External Validation of the PLASMIC Score for Rapid Assessment of Adults With Thrombotic Microangiopathies: A Cohort Study","volume":"4","author":"Bendapudi P. K.","year":"2017","journal-title":"Lancet Haematology"},{"issue":"11","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1055\/s-0037-1616068","article-title":"Towards Definition, Clinical and Laboratory Criteria, and a Scoring System for Disseminated Intravascular Coagulation","volume":"86","author":"Taylor F.","year":"2001","journal-title":"Thrombosis and Haemostasis"},{"issue":"1","key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1038\/s41408-024-01182-9","article-title":"Proteasome Inhibitors Related Thrombotic Microangiopathy: A Systematic and Comprehensive Review","volume":"14","author":"Chen C.","year":"2024","journal-title":"Blood Cancer Journal"},{"issue":"12","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"e538","DOI":"10.1016\/S1470-2045(14)70442-5","article-title":"International Myeloma Working Group Updated Criteria for the Diagnosis of Multiple Myeloma","volume":"15","author":"Rajkumar S. V.","year":"2014","journal-title":"Lancet Oncology"},{"issue":"26","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000038618","article-title":"Pulmonary Tumor Thrombotic Microangiopathy: Two Case Reports and Literature Review","volume":"103","author":"Ma H.","year":"2024","journal-title":"Medicine"},{"issue":"10","key":"e_1_2_9_10_1","article-title":"Fatal Postoperative Pulmonary Tumor Thrombotic Microangiopathy","volume":"17","author":"Hiramatsu Y.","year":"2025","journal-title":"Cureus"},{"issue":"20","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1056\/NEJMoa050010","article-title":"Sildenafil Citrate Therapy for Pulmonary Arterial Hypertension","volume":"353","author":"Gali\u00e8 N.","year":"2005","journal-title":"New England Journal of Medicine"}],"container-title":["Pulmonary Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70425","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pul2.70425","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70425","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:25:57Z","timestamp":1791901557000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pul2.70425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":10,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/pul2.70425"],"URL":"https:\/\/doi.org\/10.1002\/pul2.70425","archive":["Portico"],"relation":{},"ISSN":["2045-8940","2045-8940"],"issn-type":[{"value":"2045-8940","type":"print"},{"value":"2045-8940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-06-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70425"}}