title: Syncope: a rare presentation of massive pulmonary embolism in a previously healthy girl.
abstract: Pulmonary embolism is a very infrequent event in previously healthy children, particularly in the outpatient scenario. This report involves a 7-year-old girl who presented to the emergency room after syncope. A prompt diagnostic workup showed a massive pulmonary embolism. A timely treatment initiation permitted a good and rapid response. She represented a diagnostic and treatment challenge, mainly because of the atypical presentation and the absence of known risk factors. Finally, a thorough study uncovered a nephrotic-range urine protein loss. At the beginning, the patient did not meet the whole nephrotic syndrome diagnostic requirements. The complete thombophilic study was normal. The clinical presentation, epidemiology, diagnostic tools and the treatment of pulmonary embolism are reviewed. We also discuss a recently described risk factor, present in our patient, as a potential role in the development of pulmonary embolism.
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care, Escuela de Medicina Universidad del Desarrollo-Clínica Alemana, Santiago, Chile. rronco@alemana.cl
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ronco
authors.forename: Javiera
authors.initials: J
authors.lastname: Catalan
authors.forename: Carmen
authors.initials: C
authors.lastname: Salgado
authors.forename: Andrea
authors.initials: A
authors.lastname: Vogel
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002648:Child; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis; D009404:Nephrotic Syndrome / Q000175:diagnosis; D010949:Plasma; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000628:therapy; D013575:Syncope / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; C036309:fibrin fragment D; D005340:Fibrinogen; D006493:Heparin; D010959:Tissue Plasminogen Activator