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Fatal pulmonary embolism in a child undergoing extra-ventricular drainage surgery--a case report
1Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, R.O.C.
Insights
A fatal pulmonary embolism occurred in a 2-year-old girl following brain surgery. Echocardiography revealed widespread thrombi, leading to cardiac arrest and death, highlighting risks in pediatric neurological patients.
Area of Science:
- Neurology
- Pediatric Surgery
- Cardiology
Background:
- Thromboembolism is a significant risk for neurological patients, particularly those with brain tumors and limited mobility.
- Post-surgical complications, including venous thromboembolism (VTE), can lead to severe morbidity and mortality in pediatric cases.
Observation:
- A 2-year-old girl experienced sudden cardiac arrest during anesthesia induction for an extra-ventricular drainage procedure.
- The procedure was a sequela of a prior surgery for choroid plexus papilloma.
- Echocardiography during resuscitation showed extensive thrombi in the right atrium, right ventricle, and pulmonary arteries.
Findings:
- The cause of death was attributed to severe obstruction of the right ventricular outflow tract by large thrombi.
- Pulmonary embolism (PE) was confirmed as the fatal event.
- The case highlights a rare but devastating complication in a young patient.
Implications:
- This case underscores the critical need for vigilance regarding thromboembolic events in pediatric neurological surgery patients.
- Early diagnosis and prophylactic strategies for VTE in this population warrant further investigation.
- Understanding etiological factors and optimizing diagnostic and treatment methods for pediatric PE are crucial.
Abstract:
Thromboembolism is rather common in neurological patients and patients with brain tumor, who are bed-ridden or with partial immobile limb. In serious instances morbidity and mortality are inevitable. We present a case report on a fatal pulmonary embolism in a 2-year-old girl who underwent extra-ventricular drainage procedure under general anesthesia for occipital subdural effusion, a sequela of the former surgery undertaken to remove the choroid plexus papilloma 13 days ago. Sudden cardiac arrest occurred during induction of anesthesia and she finally succumbed in spite of vigorous cardiopulmonary resuscitation. Transthoracic and transesophageal echocardiography performed in the course of resuscitation disclosed thrombi of various sizes scattering in right atrium, the right ventricle, main pulmonary trunk, and the left pulmonary artery. The cause of death was thought to be severe obstruction of right ventricular outflow tract by large thrombi. The etiological factors which possibly led to the thrombosis were discussed, and the methods of diagnosis and treatment were also explored.