Pulmonary Embolism in Adolescents

Heparin Therapy in Pediatric Patients: A Prospective Cohort Study

“…The guidelines for the use of systemic dose heparin in newborns and children with or at risk for thromboembolic complications have been directly extrapolated from recommendations for adults (2,3). This practice has arisen because the administration of systemic dose heparin is rare enough in pediatric patients to hinder the performance of large clinical trials, yet common enough to present significant management dilemmas (4,5).…”

Bilateral pulmonary emboli after bilateral mastectomy in a 15-year-old boy with hypogonadism: A case report

“…Other risk factors such as obesity, smoking, estrogen therapy, prolonged bed rest, inherited disorders of coagulation and previous pulmonary embolism are also well accepted in the literature as known risk factors for thromboembolic complications. In addition, hypogonadism, risperidone and testosterone injections have also been shown to correlate with the incidence of deep venous thrombosis and pulmonary embolism in a small number of studies (7,21,24,25,27,(29)(30)(31). Our patient was subject to many of these risk factors.…”

“…In children and adolescents, the frequency of thromboembolic events, including pulmonary embolism, is much lower than in adults (23). A 15-year retrospective study by Bernstein et al (24) reported an incidence of 78 cases of thromboembolic complications per 100,000 hospitalized adolescents, compared with a reported incidence of between 119 and 900 cases per 100,000 hospitalized adults (25). As a consequence, pulmonary emboli are underdiagnosed in this population due, in large part, to their rarity and due to lack of clinical suspicion (23).…”

“…Pulmonary embolism can be fatal if unrecognized, and thus the first step in management is rapid identification, followed by prompt anticoagulation treatment. Patients typically present with an acute decrease in the partial pressure of oxygen and symptoms of hemoptysis, dyspnea and chest pain, although asymptomatic and atypical presentations are quite common (24). A diagnosis of pulmonary embolism is made based on the patient's clinical pretest probability and on their results from further investigation: V/Q scan, D-dimer testing and chest x-ray may all help in diagnosis (25).…”

“…In the case of our patient, whose ultrasound was negative for deep venous thrombosis, the source of his pulmonary emboli could not be identified. Other less common sources of deep venous thrombosis are the right heart and the renal and pelvic veins but, in children, it is common for the source to remain unknown (24). No reports are available on pulmonary emboli accompanying bilateral mastectomy in a pediatric patient.…”