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[Pulmonary embolism in the child: diagnostic and therapeutic particularities]
C Brasselet1, S Tassan-Mangina, P Mauran
1Département de Cardiologie, Hôpital Robert Debré, Reims.
Insights
Pulmonary embolism in children, though overlooked, is a significant condition often linked to trauma or surgery. Early diagnosis via imaging and prompt treatment with anticoagulation are crucial for managing this pediatric thromboembolic event.
Area of Science:
- Pediatric Medicine
- Cardiology
- Hematology
Context:
- Pulmonary embolism (PE) in children is an underdiagnosed condition with historical recognition dating back to the late 19th century.
- Key risk factors include trauma, surgical procedures, and the presence of foreign bodies.
- Despite its prevalence, PE in pediatric populations remains an overlooked pathology.
Purpose:
- To review the diagnostic approaches and treatment strategies for pediatric pulmonary embolism.
- To highlight the importance of recognizing risk factors and clinical presentations in children.
- To emphasize the role of anticoagulation in managing pediatric thromboembolic events.
Summary:
- Diagnosis of thrombophilia can be established following a thromboembolic event, with thrombosis potentially located anywhere in the venous system.
- Venous sonography is a primary diagnostic tool, while pulmonary embolism often presents subtly, with unexplained symptoms being a potential first sign.
- Echocardiography and ventilation-perfusion scintigraphy are key in confirming the diagnosis of pulmonary embolism.
Impact:
- Improved recognition and diagnosis of pulmonary embolism in children.
- Standardization of prophylactic and therapeutic anticoagulation protocols for pediatric patients.
- Reduced morbidity and mortality associated with pediatric thromboembolic disease.
Background:
Pulmonary embolism in children is an overlooked pathology. Yet the first description dates back to the end of the 19th century and this specific pathology is not seldom observed. The main risk factors are trauma, surgery, and foreign bodies.
Diagnosis:
Thrombophilia can be diagnosed when a thromboembolic event occurs. The initial thrombosis may be found anywhere in the venous network. Venous sonography usually gives the diagnosis. Pulmonary embolism usually has a poor clinical expression. An unexplained situation can be the first manifestation. Echocardiography guides diagnosis confirmed by ventilation-perfusion scintigraphy.
Treatment:
Prophylaxis is achieved with small doses of heparin. Treatment is based on the use of hypocoagulant doses of heparin, potentially after systemic thrombolysis and followed by oral anticoagulation.