title: A case of panic to pulmonary embolism.
abstract: Pulmonary embolism (PE) is a rare paediatric diagnosis, but its presence is likely to be underestimated due to the subtle and non-specific nature of its symptoms. Common clinical features of PE include shortness of breath, pleuritic chest pain and acute cardiovascular collapse. Less common symptoms can include persistent unexplained tachycardia, fever or deep vein thrombosis. Rarely do patients present with abdominal pain and self-resolving shortness of breath; symptoms our patient experienced. However, in contrast to popular belief, having normal vital signs does not necessarily lower the probability of PE. D-dimer, a specific fibrin degradation product, has a good negative predictive value for venous thromboembolism diagnosis but its use in children is less clear, with up to 40% of children with PE having a normal D-dimer level. CT pulmonary angiography remains the gold standard in diagnosis.
authors.affiliation: Department of Paediatrics, Tunbridge Wells Hospital, Tunbridge Wells, UK.
authors.forename: Mansum
authors.initials: M
authors.lastname: Ng
authors.affiliation: Department of Paediatrics, Maidstone and Tunbridge Wells, Kent, UK.
authors.forename: Nikila
authors.initials: N
authors.lastname: Pandya
authors.affiliation: Department of Radiology, Tunbridge Wells Hospital, Tunbridge Wells, UK.
authors.forename: Brendon
authors.initials: B
authors.lastname: Conry
authors.affiliation: Department of Haematology, Maidstone Hospital, Kent, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gale
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D010200:Panic; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000523:psychology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000925:Anticoagulants