Tahir DALKIRAN, Olcay GÜNGÖR, Yaşar KANDUR, Besra DAĞOĞLU, Can ACIPAYAM, Ayşegül ALPCAN, SERKAN TURSUN

Yanık Sonrası Pulmoner Tromboemboli Gelişen Bir Çocuk Olgu

Pulmoner tromboemboli, pediatrik yaş grubunda nadiren tanısı konulan bir hastalıktır ve tanı genellikle otopsi ile konulur. Bu çalışmada evde, sıcak su teması sebebiyle oluşan yanıktan sonra pulmoner tromboemboli gelişen bir çocuk olgusu sunulmuştur. İki bacakta ikinci derece yanık yaralanması nedeniyle 9 gün boyunca dış merkezde tedavi görmekte iken taburculuk günü, aniden solunum sıkıntısı ve bilinç kaybı ile kardiyopulmoner arrest gelişen 4 yaşındaki kız çocuğu yoğun bakım ünitemize kabul edildi. Kardiyopulmoner arrest nedeni olarak pulmoner emboli düşünülmesi üzerine hastaya akciğer bilgisayarlı tomografi ile anjiografi yapıldı. Sağ pulmoner arterin lober ve segmental dallarında trombüs saptandı. İntravenöz anfraksiyone düşük molekül ağırlıklı heparin (Enoksaparin sodyum 2×1mg / kg) tedavisine başlandı. On altıncı günde yapılan kontrol bilgisayarlı tomografi anjiyografisinde, pulmoner arterin lober ve segmental dallarındaki trombüsün kaybolduğu saptandı. Yanık hastalarında solunum sıkıntısı ile kardiyopulmoner arrest gelişmesi halinde ayırıcı tanıda pulmoner emboli mutlaka düşünülmelidir. Bu olgu sunumu hem çocuk hem de yetişkin yanık hastalarında pulmoner emboli olasılığına karşı kemoprofilaksinin önemini göstermektedir

Anahtar Kelimeler:

yanık, pulmoner tromboemboli, çocuk, heparin

PULMONARY THROMBOEMBOLISM IN A CHILD AFTER BURN INJURY

Pulmonary embolism is rarely diagnosed in pediatric burn patients and is often only discovered at autopsy. Herein we would like to present the case of a pediatric patient with pulmonary thromboembolism who was burnt by hot water at home. A 4-year-old girl who was treated at an external center for 9 days due to second degree burn injuries in both legs. After the discharge she had suddenly become restless and than gone unconscious. Since pulmonary thromboembolism was suspected as the cause of cardiopulmonary arrest, a pulmonary computed tomography angiogram was taken, which showed a thrombus in the lobar and segmental branches of the right pulmonary artery supplying the right lower lobe. Enoxaparin sodium treatment (2×1mg/kg) was initiated. At day 16, a control computed tomography angiogram showed that the thrombus in the lobar and segmental branches of the pulmonary artery had disappeared. This case report illustrates the importance of chemoprophylaxis against pulmonary embolism in both pediatric and adult burn patients. In such cases, especially the severe ones, a sudden deterioration of patient’s clinical status in the form of respiratory distress or failure should raise suspicion about the possibility of pulmonary embolism.

Keywords:

burn, pulmoner thromboembolism, pediatric, heparin,

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