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Published on: November 4, 2015
MDCT pulmonary angiography evaluation of pulmonary embolism in children
Supika Kritsaneepaiboon1, Edward Y Lee, David Zurakowski
1Department of Radiology, Children's Hospital Boston and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
Insights
Pulmonary embolism (PE) may be more common in children than previously thought. This study found PE prevalence and distribution in pediatric patients are similar to adults, highlighting the need for awareness.
Area of Science:
- Pediatric Radiology
- Cardiovascular Imaging
- Pulmonary Medicine
Background:
- Pulmonary embolism (PE) diagnosis in children is challenging.
- MDCT pulmonary angiography (pulmonary CTA) is a key imaging modality.
Purpose of the Study:
- To determine the prevalence and anatomic distribution of PE in pediatric patients with suspected PE.
- Utilize multi-detector computed tomography pulmonary angiography (MDCT pulmonary CTA) for diagnosis.
Main Methods:
- Retrospective review of 98 pulmonary CTA studies in pediatric patients (<18 years) from July 2004 to August 2007.
- Consensus review by two pediatric radiologists to assess PE presence and location (central, lobar, segmental, subsegmental).
- Comparison with lower extremity ultrasound in a subset of patients.
Main Results:
- 15.5% (13 of 84) of pediatric patients had PE confirmed by pulmonary CTA.
- PE commonly involved lobar (39%) and segmental (35%) arteries, with distribution across all lung lobes.
- Subsegmental artery evaluation was limited in 80% of studies; deep venous thrombosis was found in one patient with PE.
Conclusions:
- The prevalence of PE in pediatric patients may be underestimated.
- The anatomic distribution of PE in children mirrors that observed in adult populations.
- Pulmonary CTA is effective for diagnosing PE in children, though subsegmental vessel visualization can be limited.
Objective:
The purpose of our study was to determine the prevalence and anatomic distribution of pulmonary embolism (PE) in a group of consecutive pediatric patients with clinically suspected PE using MDCT pulmonary angiography (pulmonary CTA).
Materials And Methods:
We used our hospital information system to retrospectively identify all consecutive pediatric patients (< 18 years of age) with clinically suspected PE who underwent pulmonary CTA from July 2004 to August 2007. Two experienced pediatric radiologists retrospectively reviewed by consensus a series of 98 consecutive pulmonary CTA studies. Each examination was reviewed for the ability to visualize pulmonary arteries and the presence of PE. For positive cases, the level of involvement was classified as central, lobar, segmental, or subsegmental. Lobar location was also recorded using standard nomenclature. Pulmonary CTA results were compared with the results of lower extremity ultrasound studies in the subset of patients who underwent both procedures.
Results:
The study population consisted of 84 children who underwent a total of 98 pulmonary CTA studies. All pulmonary CTA studies were technically successful in visualizing arteries to the level of segmental pulmonary arteries, but the evaluation of subsegmental pulmonary arteries was limited in 78 (80%) examinations. Thirteen (15.5%) of 84 children were found to have PE on pulmonary CTA. PE was localized in the lobar pulmonary artery in 12 (39%), the segmental pulmonary artery in 11 (35%), the subsegmental pulmonary artery in five (16%), and the main or central pulmonary artery in three (10%) patients. PE was distributed in the right lower lobe in 12 (37%), the left lower lobe in eight (24%), the right upper lobe in five (15%), the right middle lobe in four (12%), and the left upper lobe in four (12%) patients. Ten of 13 patients with PE underwent lower extremity Doppler ultrasound, of whom one (10%) was positive for deep venous thrombosis.
Conclusion:
The prevalence of PE may be more common among pediatric patients than previously reported and has a similar distribution to that in adult patients.
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