Pulmonary embolism in children

Buck, James R.; Connors, Robert H.; Coon, William W.; Weintraub, William H.; Wesley, John R.; Coran, Arnold G.

doi:10.1016/s0022-3468(81)80700-2

Cited by 160 publications

(73 citation statements)

References 18 publications

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“…A recent retrospective cohort study in a single tertiary Canadian centre found a comparable direct cause mortality of 8AE9% (Biss et al, 2008). Autopsy studies show that PE is under diagnosed and so the risk of mortality may actually be higher than indicated by these studies (Buck et al, 1981). A potential longterm complication of PE is pulmonary hypertension, which is seen in 3AE8% of adults at 2 years (Pengo et al, 2004).…”

Section: Morbidity and Mortality Associated With Vte In Childrenmentioning

confidence: 99%

Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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Section: Morbidity and Mortality Associated With Vte In Childrenmentioning

confidence: 99%

Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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“…Retrospective autopsy studies in children have indicated an incidence of PE at autopsy of 0.73% to 3.7%, depending on the population studied. 225,226 The incidence of PE in children is less than in adults and may be related to unique protective mechanisms, including decreased thrombin generation, increased levels of the inhibitor of coagulation α 2 -macroglobulin, and enhanced antithrombotic potential of the vessel wall 12,13,[168][169][170][171][172] (section 2.5, Developmental Hemostasis).…”

Section: Pe In Chdmentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

297

245

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“…It is uncommon in pediatric population and indeed it could be under-recognized clinically and often discovered at postmortem examinations [2][3][4][5]. The exact incidence of the disease in pediatric population is unknown, about 0.9 per 100,000 children per year according to National Discharge Survey [2].…”

Section: Discussionmentioning

confidence: 99%

“…These symptoms appear only in patients with large embolism that occludes more than 50% of lung vascular bed, as consequence many cases due to smaller emboli remain silent. Only about half of young patients with PE manifests symptoms and signs of the disease, moreover the diagnosis is suspected in only one third of them [5]. Furthermore, children have a good pulmonary reserve which may reduce haemodynamic consequences of massive PE.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Embolism in Children: A Report of Two Cases

Marcì¹,

Castiglione²,

Sanfilippo³

2016

JCCR

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Submit Manuscript | http://medcraveonline.com (>99° percentile), height=110 cm, (BMI=41); the heart sounds were normal, a 2/6 Levine murmur was audible on the right sternal border; the breath sounds were diminished bilaterally, the peripheral oxygen saturation was 80%. The arterial blood gas analysis (ABG) revealed respiratory alkalosis (pH=7, 50), pO 2 =93 mmHg, pCO 2 =30mmHg. Endo-tracheal intubation and mechanical ventilation with 100% oxygen was necessary, furthermore a venous central catheter was placed into the right femoral vein. The chest X-ray study revealed bilateral infiltrates. Since a pneumonia was suspected the patient was treated with antibiotics (Teicoplanin and Ceftriaxone). Over six days, as the clinical conditions improved and the child was estubated, the venous central catheter was removed and she was transferred to the Pediatric Clinic. After one day the conditions suddenly worsened with dyspnea and signs of deep-vein thrombosis of the right limb, which was swollen and warm. Doppler ultrasound scan showed femoro-popliteal deep venous thrombosis. The echocardiography revealed a mildly dilatation of right ventricle and of inferior vena cava. Color -Doppler examination demonstrated a moderatesevere tricuspidal regurgitation, with a high atrio-ventricular peak pressure gradient (65 mmHg).D-dimer was sevenfold the upper limit. A second chest radiograph showed a mild left pleural effusion. Because P.E. was suspected the patient underwent a contrast enhanced computed tomography (CT) of the thorax that demonstrated clots into the upper and lower lobar right pulmonary arteries (Figure 1). The girl was treated with LMWH followed by warfarin with resolution of symptoms. Further laboratory tests for thrombophilia screening revealed methylene tetrahydrofolate reductase heterozygotes mutation with normal homocysteine plasma level and heterozygotes mutation of the Factor II (G20210A). The patient was discharged from hospital on oral anticoagulant therapy for six months and with a hypo-caloric diet.The second patient was a 10-years-old girl, affected by mental retardation and tetraplegia due to neonatal hypoxemia. Initially, he was admitted to nephrology department for anuria, elevated creatine (3mg/dL) and pedal swelling. Physical examination revealed a diaphoretic and tachypneic patient, with a heart rate of 140 beats/min, the pulse oxygen saturation in room air was 88% and failed to rise under supplemental oxygen (3 L/ min with nasal cannula), severe hypotension (systolic blood pressure <90mmHg), the heart sounds were normal while the breath sounds were diminished bilaterally, moreover jugular veins distension was noted. The ABG showed metabolic acidosis (pH = 7.2 and low bicarbonates =16 mmol/L), hypoxemia (pO 2 = 50 mmHg) and hypocapnia (pO 2 = 32 mmHg). Tachycardia and hypotension prompted an echocardiogram that showed dilatation and dysfunction of right ventricle, mild dilatation of inferior vena cava and moderate tricuspid insufficiency, with a peak velocity of 3, 3 m/s, which predicts a systolic pu...

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Pulmonary embolism in children

Cited by 160 publications

References 18 publications

Aspects of anticoagulation in children

Aspects of anticoagulation in children

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Pulmonary Embolism in Children: A Report of Two Cases

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