Pediatric Pulmonary Embolism: Diagnostic and Management Challenges

2016 ◽  
Vol 9 (1) ◽  
pp. 110-113 ◽  
Author(s):  
Christian Lilje ◽  
Aman Chauhan ◽  
Jason P. Turner ◽  
Thomas H. Carson ◽  
Maria C. Velez ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Functional Assessment ◽  
Rare Case ◽  
Three Dimensional ◽  
Massive Pulmonary Embolism ◽  
Pulmonary Angiography ◽  
Computed Tomography Pulmonary Angiography ◽  
Dimensional Reconstruction ◽  
Surgical Embolectomy ◽  
Prophylactic Anticoagulation

A rare case of massive pulmonary embolism is presented in an oligosymptomatic teenager with predisposing factors. Computed tomography pulmonary angiography supported by three-dimensional reconstruction was diagnostic. The embolus qualified as massive by conventional anatomical guidelines, but as low risk by more recent functional criteria. Functional assessment has complemented morphologic assessment for risk stratification in adult patients. Such evidence is scarce in pediatrics. The patient underwent surgical embolectomy, followed by prophylactic anticoagulation, without further events. Diagnostic and management challenges are discussed.

scholarly journals Three-Dimensional Reconstruction Algorithm for CT Pulmonary Angiography in Patients with Pulmonary Embolism Combined with Syncope

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhongxing Zhang ◽  
Yan Zhang ◽  
Xiaohui Wang ◽  
Xiaoli Han ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
3D Reconstruction ◽  
Clinical Characteristics ◽  
Three Dimensional ◽  
Reconstruction Algorithm ◽  
Pulmonary Angiography ◽  
Mesh Simplification ◽  
Ct Pulmonary Angiography ◽  
Dimensional Reconstruction ◽  
The Difference

This paper aimed to study the clinical characteristics of patients with pulmonary embolism (PE) with syncope (PE + S) based on the three-dimensional (3D) reconstruction algorithm in computed tomography (CT) pulmonary angiography (CTPA). In this study, 857 patients with acute PE (APE) who were treated in hospital were selected as the research objects and divided into syncope group (group S) and nonsyncope group (group NS). The 3D reconstruction marching cubes (3DR-MC) algorithm was compared with the traditional MC (T-MC) algorithm and the mesh simplification MC (MMS-MC) algorithm, and the results proved that the running time of the 3DR-MC algorithm on the platform was shorter than that of the other two algorithms. The incidence of syncope in group S in women was higher than that in group NS (51.7% vs. 38.2%). The incidence of syncope classified as high risk in group S was higher than that in group NS, and the mortality rate of pulmonary embolism patients with syncope was higher, and the difference was statistically significant (χ2 = 113.332, P < 0.05 ). The incidence of syncope in group S was higher than that in group NS (χ2 = 4.074, P < 0.05 ). In short, hypertension was an independent risk factor for syncope. PE + S patients could be diagnosed and treated as early as possible based on the clinical characteristics, so as to reduce the adverse consequences of misdiagnosis.

scholarly journals CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

2020 ◽  
pp. 33-34
Author(s):  
Mantavya Patel ◽  
Sanjay Paliwal ◽  
Rachit Saxena
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Early Prediction ◽  
Computed Tomography Pulmonary Angiography ◽  
Negative Prediction ◽  
D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

scholarly journals Pulmonary embolism severity before and during the COVID-19 pandemic

2021 ◽  
pp. 20210264
Author(s):  
Vicky Tilliridou ◽  
Rachael Kirkbride ◽  
Rebecca Dickinson ◽  
James Tiernan ◽  
Guo Liang Yong ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Frequency ◽  
Pulmonary Angiography ◽  
Demographic Information ◽  
Right Heart ◽  
Computed Tomography Pulmonary Angiography ◽  
Health Records ◽  
Retrospective Audit ◽  
Increased Risk ◽  
Age And Sex

Objectives: Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. Methods: In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. Results: In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). Conclusion: During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. Advances in knowledge: During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.

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