Advertisement

Pulmonary thromboembolism in childhood: A single-center experience from Turkey

      Objective

      This study was designed to evaluate the clinical characteristics, acquired and congenital risk factors, treatment strategies, and long-term outcome in pediatric pulmonary thromboembolism (PTE) cases followed in our center in Turkey.

      Subjects

      Of the total 470 pediatric patients with thrombosis referred to our center, 16 (3.4%) had PTE. The mean age of the children with PTE was 10.3 ± 6.8 years (range: 1.5–20.0, median: 10.5), and 12 (75.0%) were boys.

      Results

      The mean follow-up period was 28.9 ± 21.0 months (range: 3–66, median: 22). During the follow-up period, recurrence was observed in three children (18.8%). The mean time from the appearance of symptoms to accurate diagnosis was 6.4 ± 4.0 days (range: 2–10). Six patients (37.5%) were initially diagnosed as having pneumonia. After they were hospitalized and showed no clinical improvement with broad-spectrum antibiotic treatment, the accurate diagnosis of PTE was established. Of these 16 patients with PTE, 8 (50%) had associated thrombosis and 6 (37.5%) had congenital heart diseases. Infections including septic arthritis and osteomyelitis (n = 1), cytomegalovirus infection (n = 1), and infective endocarditis (n = 2) were detected in our patient group. In addition, two patients had a central venous line and one patient had obesity associated with malignancy. Other underlying diseases included thalassemia major, Behçet disease, antiphospholipid antibody syndrome, and autoimmune lymphoproliferative disorder in one patient each. Factor V G1691A heterozygous mutation was detected in two children, and methylene tetrahydrofolate reductase C677T homozygous mutation was detected in one child. A high level of factor VIII was the most common (8/16, 50%) laboratory risk factor in our patient group, and 12 children (75.0%) had a high D-dimer level. Among 16 children with PTE, one child had one, three children had two, five children had three, three children had four, and four children had five laboratory and/or clinical risk factors. Therefore, all children with PTE had at least one laboratory and/or clinical risk factor that facilitated development of thrombosis. In addition, according to the risk assessment for persistence or recurrence of venous thrombosis in children conducted by Manco-Johnson, 12 children (75%) with PTE in the present study had high-risk criteria.

      Conclusion

      When a child with thrombosis at any site of the body develops unexpected respiratory symptoms or pneumonia unresponsive to antibiotic treatment, imaging studies should be performed for diagnosis of PTE. Furthermore, thrombotic children with high-risk criteria should be followed closely for the development of PTE.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Babyn P.S.
        • Gahunia H.K.
        • Massicotte P.
        Pulmonary thromboembolism in children.
        Pediatr Radiol. 2005; 35: 258-274
        • Andrew M.
        • David M.
        • Adams M.
        • et al.
        Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE.
        Blood. 1994; 83: 1251-1257
        • Rajpurkar M.
        • Warrier I.
        • Chitlur M.
        • et al.
        Pulmonary embolism-experience at a single children's hospital.
        Thromb Res. 2002; 113: 633-703
        • Olivier C.
        • Blondiaux E.
        • Blanc T.
        • Borg J.Y.
        • Dacher J.N.
        Catastrophic antiphospholipid syndrome and pulmonary embolism in a 3-year-old child.
        Pediatr Radiol. 2006; 36: 870-873
        • Sridhar A.V.
        • Rao N.K.
        • Chakraborty S.
        A six-year-old with fatal pulmonary embolism.
        Acta Paediatr. 2005; 94: 977-979
        • Rai Mittal B.
        • Singh S.
        • Bhattacharya A.
        • Prasad V.
        • Singh B.
        Lung scintigraphy in the diagnosis and follow-up of pulmonary thromboembolism in children with nephrotic syndrome.
        Clin Imaging. 2005; 29: 313-316
        • Athanassiadou F.
        • Kourti M.
        • Tragiannidis A.
        • et al.
        Pulmonary embolism due to invasive aspergillosis in a child with acute myelogenous leukemia.
        Pediatr Blood Cancer. 2005; 45: 1001-1002
        • Byard R.W.
        • Cutz E.
        Sudden and unexpected death in infancy and childhood due to pulmonary thromboembolism.
        Arch Pathol Lab Med. 1990; 114: 142-144
        • Buck J.R.
        • Connors R.H.
        • Coon W.W.
        • Weintraub W.H.
        • Wesley J.R.
        • Coran A.G.
        Pulmonary embolism in children.
        J Pediatr Surg. 1981; 16: 385-391
        • van Ommen C.H.
        • Heijboer H.
        • Buller H.R.
        • Hirasing R.A.
        • Heijmans H.S.
        • Peters M.
        Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands.
        J Pediatr. 2001; 139: 676-681
        • Bertina R.M.
        • Koeleman B.P.
        • Koster T.
        • et al.
        Mutation in blood coagulation factor V associated with resistance to activated protein C.
        Nature. 1994; 369: 64-67
        • Poort S.R.
        • Rosendaal F.R.
        • Reitsma P.H.
        • Bertina R.M.
        A common genetic variation in the 3'-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in venous thrombosis.
        Blood. 1996; 88: 3698-3703
        • Goyette P.
        • Sumner J.S.
        • Milos R.
        • et al.
        Human methylenetetrahydrofolate reductase: isolation of cDNA, mapping and mutation identification.
        Nat Genet. 1994; 7: 195-200
        • Manco-Johnson M.J.
        How I treat venous thrombosis in children.
        Blood. 2006; 107: 21-29
        • Hoyer P.F.
        • Gonda S.
        • Barthels M.
        • Krohn H.P.
        • Brodehl J.
        Thromboembolic complications in children with nephrotic syndrome.
        Acta Paediatr Scand. 1986; 75: 804-810
        • Desai M.H.
        • Linares H.A.
        • Herndon D.N.
        Pulmonary embolism in burned children.
        Burns. 1989; 15: 376-380
        • Hsu D.T.
        • Addonizio L.J.
        • Hordof A.J.
        • Gersony W.M.
        Acute pulmonary embolism in pediatric patients awaiting heart transplantation.
        J Am Coll Cardiol. 1991; 17: 1621-1625
        • Marraro G.
        • Uderzo C.
        • Marchi P.
        • Castagnini G.
        • Vaj P.L.
        • Masera G.
        Acute respiratory failure and pulmonary thrombosis in leukemic children.
        Cancer. 1991; 67: 696-702
        • Uderzo C.
        • Marraro G.
        • Riva A.
        • et al.
        Pulmonary thromboembolism in leukaemic children undergoing bone marrow transplantation.
        Bone Marrow Transplant. 1993; 11: 201-203
        • McBride W.J.
        • Gadowski G.R.
        • Keller M.S.
        • Vane D.W.
        Pulmonary embolism in pediatric trauma patients.
        J Trauma. 1994; 37: 913-915
        • Nuss R.
        • Hays T.
        • Manco-Johnson M.
        Childhood thrombosis.
        Pediatrics. 1995; 96: 291-294
        • Monagle P.
        • Adams M.
        • Mahoney M.
        • et al.
        Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry.
        Pediatr Res. 2000; 47: 763-766
        • van Ommen C.H.
        • Peters M.
        Acute pulmonary embolism in childhood.
        Thromb Res. 2006; 118: 13-25
        • Michaeli J.
        • Mittelman M.
        • Grisaru D.
        • Rachmilewitz E.A.
        Thromboembolic complications in beta thalassemia major.
        Acta Haematol. 1992; 87: 71-74
        • Gurgey A.
        • Aslan D.
        Outcome of noncatheter-related thrombosis in children: influence of underlying or coexisting factors.
        J Pediatr Hematol Oncol. 2001; 23: 159-164
        • Schoepf U.J.
        • Goldhaber S.Z.
        • Costello P.
        Spiral computed tomography for acute pulmonary embolism.
        Circulation. 2004; 109: 2160-2167