Pediatric pulmonary embolism: Unveiling clinical manifestations, diagnostic challenges, and outcomes in Southwest China

Abstract

Pulmonary embolism (PE) leads to obstruction of pulmonary circulation, resulting in increased pulmonary vascular resistance, elevated pulmonary arterial pressure, and increased right heart load. In severe cases, it can lead to cardiac decompensation and life-threatening conditions. However, clinical studies on PE in children are limited, with many diagnostic and treatment guidelines derived from adult populations. We retrospectively analyzed the clinical manifestations, risk factors, co-morbidity, and outcomes of PE patients admitted to a large children's hospital in southwest China. A total of 24 children with PE participated, 9 boys (37.5%), aged 0.1–14.6, (median: 8.15 years old). Except for two asymptomatic cases, the duration from symptom onset to the diagnosis of PE varied from 2 to 45 days (median: 12 days). Among these children, 13 (54.2%) patients experienced a delayed diagnosis exceeding 10 days. A total of 7 children died from underlying diseases, and no one met the outcome of recurrent PE or PE-related death. Among the 17 survivors, complete resolution of PE was in 11 (64.7%) children, partial resolution who progressed to chronic PE was in 3 (17.7%) children, and no follow-up computed tomography pulmonary angiography was performed in the remaining 3 (17.7%) children. This study revealed that the majority of pediatric PE cases presented with respiratory symptoms, with a considerable proportion initially misdiagnosed as pneumonia, and emphasized the importance of early recognition and appropriate management strategies in improving outcomes for the affected children. Further research is warranted to elucidate the pathophysiology, refine diagnostic algorithms, and establish standardized treatment protocols tailored to the pediatric population.

Keywords

children / delayed diagnosis / outcomes / pathology / pulmonary embolism

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2024 The Author(s). Pediatric Discovery published by John Wiley & Sons Australia, Ltd on behalf of Children's Hospital of Chongqing Medical University.