Melih HANGÜL, Mehmet KÖSE, Ali ERSOY, Aslı İmran YILMAZ, Sevgi PEKCAN, Ümran ÇALIŞKAN, Hüseyin TOKGÖZ, Tahir TOK, Ayşe Tana ASLAN, Tuğba Şişmanlar EYÜBOĞLU, Tuğba Ramaslı GÜRSOY, Nihan KIRÇIL

Pulmonary Embolism in Childhood: A Multicenter Experience from Turkey

Background: Pulmonary embolism is a clinical condition caused by the obstruction of the pulmonary artery and its branches with endogenous, exogenous embolism, or local thrombus formation. It is a rare but potentially life-threatening event in the pediatric population. Pediatric pulmonary embolism has many unknown characteristics. Aims: To evaluate clinical features, genetic and acquired risk factors, diagnostic imaging, and treatment strategies with long-term results in children with pulmonary embolism. Study Design: A retrospective multicenter clinical trial Methods: Patients aged 0-18 years who were diagnosed with pulmonary embolism with computed tomography pulmonary angiography (CTPA) findings (intraluminal filling defect in the lobar or main pulmonary artery) in 3 university hospitals between 2006 and 2021 were included in the study. A form was created for data standardization, and variables were collected retrospectively through medical record review. In addition to the features given above, we also evaluated in situ pulmonary artery thrombosis (ISPAT) and patients’ Wells scores. Follow-up CTPA results were evaluated for patient response to treatment. Complete recovery means that there were no lesions, incomplete recovery if there was still embolism, and no response if there was no change. Results: Twenty-four patients (female:13, male:11) were included in the study. The mean age was 13.5 years. All patients but one had at least one or more genetic or acquired risk factors. Factor V Leiden mutation (16.6%) was the most common genetic risk factor. Six of 16 patients with Doppler ultrasonography were diagnosed with ISPAT because there was no sign of thromboembolic thrombosis. Nine (41.6%) patients had a Wells score of >4 (pulmonary embolism clinically strong), and 15 (58.4%) patients scored

PDF

___

Babyn PS, Gahunia HK, Massicotte P. Pulmonary thromboembolism in children. Pediatr Radiol. 2005;35:258-274. [CrossRef]
Dijk FN, Curtin J, Lord D, Fitzgerald DA. Pulmonary embolism in children. Paediatr Respir Rev. 2012;13:112-22. [CrossRef]
Wells PS, Anderson DR, Rodger M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost. 2000;83:416-420. [CrossRef]
Rajpurkar M, Biss T, Amankwah EK, et al. Pulmonary embolism and in situ pulmonary artery thrombosis in pediatrics. A systematic review. Thromb Haemost. 2017;117:1199-1207. [CrossRef]
Carpenter SL, Richardson T, Hall M. Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014. Blood Adv. 2018;2:1403-1408. [CrossRef]
Ramiz S, Rajpurkar M. Pulmonary Embolism in Children. Pediatr Clin North Am. 2018;65:495-507. [CrossRef]
Biss TT, Brandão LR, Kahr WH, Chan AK, Williams S. Clinical features and outcome of pulmonary embolism in children. Br J Haematol. 2008;142:808-818. [CrossRef]
Babyn PS, Gahunia HK, Massicotte P. Pulmonary thromboembolism in children. Pediatr Radiol. 2005;35:258-274. [CrossRef]
Tavil B, Kuskonmaz B, Kiper N, Cetin M, Gumruk F, Gurgey A. Pulmonary thromboembolism in childhood: a single-center experience from Turkey. Heart Lung. 2009;38:56-65. [CrossRef]
Van Ommen CH, Peters M. Acute pulmonary embolism in childhood. Thromb Res. 2006;118:13-25. [CrossRef]
Rajpurkar M, Warrier I, Chitlur M, et al. Pulmonary embolism-experience at a single children’s hospital. Thromb Res. 2007;119:699-703. [CrossRef]
Hennelly KE, Baskin MN, Monuteuax MC, et al. Detection of Pulmonary Embolism in High-Risk Children. J Pediatr. 2016;178:214-218. [CrossRef]
Navanandan N, Stein J, Mistry RD. Pulmonary Embolism in Children. PediatrEmerg Care. 2019;35:143-151. [CrossRef]
American College of Emergency Physicians Clinical Policies Committee; Clinical Policies Committee Subcommittee on Suspected Pulmonary Embolism. Clinical policy: critical issues in the evaluation and management of adult patients presenting with suspected pulmonary embolism. Ann Emerg Med. 2003;41:257-270. Erratum in: Ann Emerg Med. 2003;42:288. [CrossRef]
Biss TT. Pulmonary embolism in childhood: how can we be sure not to miss it? Arch Dis Child. 2018;103:814-816. [CrossRef]
Buck JR, Connors RH, Coon WW, Weintraub WH, Wesley JR, Coran AG. Pulmonary embolism in children. J Pediatr Surg. 1981;16:385-391. [CrossRef]
Stein PD, Kayali F, Olson RE. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004;145:563- 565. [CrossRef]
Celkan T, Dikme G. Thrombosis in children: Which test to whom, when and how much necessary? Turk Pediatri Ars. 2018;53:1-9. [CrossRef]
Cha SI, Choi KJ, Shin KM, et al. Clinical characteristics of in-situ pulmonary artery thrombosis in Korea. Blood Coagul Fibrinolysis. 2015;26:903-907. [CrossRef]
Ozyurt A, Baykan A, Kose M, Karakukcu M, Mavili E, Patiroglu T. Pulmonary thromboembolism associated with pulmonary venous thrombus: a paediatric case report. Heart Lung Circ. 2014;23:e80-e83. [CrossRef]
Navanandan N, Stein J, Mistry RD. Pulmonary Embolism in Children. Pediatr Emerg Care. 2019;35:143-151. [CrossRef