title: Pulmonary embolism-experience at a single children's hospital.
abstract: BACKGROUND
  Pulmonary embolism in children is a rare, potentially life threatening condition. The clinical characteristics of pediatric pulmonary embolism have not been well studied and the exact incidence in children is not known. We report a case series of fourteen patients with pulmonary embolism and describe their clinical characteristics.
  
  
  METHODS
  Inpatient and outpatient clinic charts of patients with proven pulmonary embolism (PE) followed at the Hemostasis and Thrombosis Center at Children's Hospital of Michigan were reviewed for relevant clinical and laboratory information.
  
  
  RESULTS
  All patients with PE were symptomatic but accurate diagnosis of PE was often delayed in the outpatient setting. Screening testing with D-dimer was normal in 40% of patients. Acquired risk factors and lower extremity clots were more common in patients analyzed. Treatment regimens differed but most patients had resolution of pulmonary emboli on follow-up.
  
  
  CONCLUSIONS
  A high index of suspicion is needed for the diagnosis of pediatric PE. D-Dimer may be normal in some children with PE. Pediatric multicenter trials are needed to evaluate clinical characteristics, risk factors, long-term outcome and effects of PE on pulmonary and cardiac function.
authors.affiliation: Division of Hematology Oncology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan 48201, USA. mrajpurk@med.wayne.edu
authors.forename: Madhvi
authors.initials: M
authors.lastname: Rajpurkar
authors.forename: Indira
authors.initials: I
authors.lastname: Warrier
authors.forename: Meera
authors.initials: M
authors.lastname: Chitlur
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sabo
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Frey
authors.forename: Wendy
authors.initials: W
authors.lastname: Hollon
authors.forename: Jeanne
authors.initials: J
authors.lastname: Lusher
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006776:Hospitals, Pediatric; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D010045:Outpatients; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D012307:Risk Factors; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D