title: Cardiac, lung, and brain thrombosis in a child with obstructive sleep apnea.
abstract: A 3-year-old boy with failure to thrive and severe adenotonsillar hypertrophy with a clinical presentation of prolonged obstructive sleep apnea (OSA), was referred to the emergency room due to severe respiratory distress and anasarca. Echocardiography revealed right heart failure, a cystic lesion in the right ventricle and severe pulmonary hypertension. D-dimer was elevated but spiral computerized tomography (CT) and lung scan did not show any perfusion defects. Excision of the cardiac lesion during open-heart surgery, lung biopsy, and adenotonsillectomy were performed. Pathological examination showed an intracadiac organized thrombus and eccentric intimal fibrosis of the pulmonary arteries-which is a pathognomonic of pulmonary arterial microemboli. Brain CT revealed vein thrombosis of the left sigmoid sinus. Blood tests for inherited thrombophilia were normal. Today, 5 years after adenotonsillectomy, the child is normally developed, completely asymptomatic, free of any medications, and has a normal echocardiography. This case report may indicate that prolonged OSA can be a procoagulant state which can cause severe cardiovascular morbidity in children.
authors.affiliation: Institute of Pulmonology, Hadassah Ein Kerem, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel. shlomoco@hadassah.org.il
authors.forename: Shlomo
authors.initials: S
authors.lastname: Cohen
authors.forename: Chaim
authors.initials: C
authors.lastname: Springer
authors.forename: Zeev
authors.initials: Z
authors.lastname: Perles
authors.forename: Benjamin Z
authors.initials: BZ
authors.lastname: Koplewitz
authors.forename: Avraham
authors.initials: A
authors.lastname: Avital
authors.forename: Shoshana
authors.initials: S
authors.lastname: Revel-Vilk
mesh_terms: D000233:Adenoidectomy; D000234:Adenoids / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001777:Blood Coagulation / Q000187:drug effects; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000601:surgery; D002675:Child, Preschool; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D006337:Heart Murmurs / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D009569:Nitric Oxide / Q000627:therapeutic use; D014066:Palatine Tonsil / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D011859:Radiography; D012135:Respiratory Sounds / Q000187:drug effects / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D014068:Tonsillectomy; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D004232:Diuretics; D009569:Nitric Oxide