Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion.
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.


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.


CONCLUSIONS
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.
Victoria
Teresa
T
Department of Radiology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19103, USA. victoria@email.chop.edu
Mong
Andrew
A
Altes
Talissa
T
Jawad
Abbas F
AF
Hernandez
Andrea
A
Gonzalez
Leonardo
L
Raffini
Leslie
L
Kramer
Sandra S
SS
D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D015995:Prevalence; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013902:Radiography, Thoracic; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult