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Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion
Teresa Victoria1, Andrew Mong, Talissa Altes
1Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19103, USA. victoria@email.chop.edu
Insights
Pulmonary embolism (PE) is common in children with high suspicion, affecting 14% of cases. Risk factors include surgery, blood disorders, and contraceptive use, with girls being more susceptible.
Area of Science:
- Pediatric Medicine
- Radiology
- Cardiology
Background:
- Pulmonary embolism (PE) is frequently underdiagnosed in children due to low clinical suspicion.
- Increased awareness is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To determine the prevalence of PE in a pediatric population with high clinical suspicion.
- To identify associated risk factors and characteristic imaging findings.
Main Methods:
- Retrospective review of 92 patients (age ≤21) with suspected PE from 2003-2006.
- Case group: positive CT scan or V/Q scan; Control group: high suspicion, no PE/DVT evidence, matched for age/sex.
- Analysis of patient charts and imaging studies.
Main Results:
- PE prevalence was 14% in children with high suspicion; overall thromboembolic disease (PE and/or DVT) was 25%.
- Risk factors included recent surgery, orthopedic procedures, blood dyscrasias, and contraceptive use.
- Girls were twice as likely to develop PE; no fatalities occurred, youngest patient was 13.
Conclusions:
- PE is a significant diagnosis in pediatric tertiary care when clinical suspicion is high.
- Recommendations include heightened awareness and prompt diagnostic imaging for suspected PE.
Background:
Pulmonary embolism (PE) is an underdiagnosed entity in the pediatric population in part because of the low level of suspicion and awareness in the clinical world.
Objective:
To examine its relative prevalence, associated risk factors and imaging features in our pediatric population.
Materials And Methods:
A total of 92 patients age 21 years and younger with a high clinical suspicion of PE and who had available radiographic studies were identified from January 2003 to September 2006. Patients with a positive CT scan or a high probability ventilation/perfusion scan formed the case group; patients with a high clinical suspicion of PE and no radiographic evidence of PE or deep venous thrombosis (DVT), randomly matched in age and sex, became the matched control group. We reviewed the charts of both groups and analyzed the imaging studies.
Results:
In our hospital, the prevalence of PE in patients with a strong suspicion of PE was 14%. The overall prevalence of thromboembolic disease (PE and/or DVT) was 25%. Recent surgery or orthopedic procedure, blood dyscrasias and contraceptive use were more common in patients with PE. No child died of PE in our study. The youngest child with PE in our study was 13 years. Girls were twice as likely to develop PE as boys.
Conclusion:
PE is a relatively common diagnosis in our tertiary care pediatric population when the clinical suspicion is high. We suggest increased awareness and index of suspicion in order to initiate prompt diagnostic imaging and treatment.
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