Pulmonary embolism-experience at a single children's hospital.
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.
Rajpurkar
Madhvi
M
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
Warrier
Indira
I
Chitlur
Meera
M
Sabo
Cynthia
C
Frey
Mary Jane
MJ
Hollon
Wendy
W
Lusher
Jeanne
J
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
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D006495:Heparin, Low-Molecular-Weight; C036309:fibrin fragment D