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[Pulmonary thromboembolism in children]
C J Sánchez Díaz1, A Ramírez Rivera, C Ibarra-Pérez
1Hospital de Cardiología Luis Méndez, Centro Médico Nacional, IMSS, México, D.F.
Insights
Pulmonary embolism and infarction in children, even those without prior heart or lung issues, present similarly to adults. Early diagnosis is crucial to prevent complications like cavitations in pulmonary infarction.
Area of Science:
- Pediatric Pulmonology
- Pediatric Cardiology
- Diagnostic Imaging
Context:
- Pulmonary embolism (PE) and infarction are uncommon but serious conditions in children.
- Risk factors, clinical presentation, and electrocardiogram (ECG) findings in pediatric PE can mimic those in adults.
- Children may present with diverse underlying conditions, including congenital heart disease, rheumatic cardiopathy, or previously healthy cardiopulmonary systems.
Purpose:
- To describe the clinical experience with five pediatric cases of pulmonary embolism and infarction.
- To highlight the diagnostic challenges and imaging findings in this patient population.
- To emphasize the importance of considering PE in children with respiratory failure.
Summary:
- Five children with pulmonary embolism and infarction were analyzed.
- Clinical features and ECG findings were comparable to adult presentations.
- Delayed diagnosis in three cases led to pulmonary infarction with cavitations, identified via perfusion gammagraphy.
- Hypoxemia and hypocapnia were consistent findings, with diagnosis confirmed by imaging or autopsy.
Impact:
- This study underscores the necessity of maintaining a high index of suspicion for pulmonary embolism in pediatric patients experiencing respiratory failure.
- It highlights the utility of perfusion gammagraphy in diagnosing PE in children.
- Recognizing PE in children is vital for timely intervention and improved outcomes, even in those without pre-existing cardiopulmonary disease.
Abstract:
We report our experience with five children with pulmonary embolism and infarction. Two with congenital heart disease, one with rheumatic cardiopathy and two with a previously healthy cardiopulmonary system. The risk factors, clinical behavior and ECG were similar to those in adults. In chest roentgenogram we found pulmonary infarction with cavitations in three patients because of a delayed diagnosis. All patients had hypoxemia and hypocapnia, and diagnosis was made on the basis of segmentary or larger defects in perfusion gammagraphy. In just one case we obtained V/Q gammagraphy and pulmonary angiography. In one case we confirmed the clinical diagnosis by autopsy. We conclude that it is very important to keep this diagnosis in mind in all children with respiratory failure.