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Pulmonary Embolism

Pulmonary Embolism is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

Occlusion of a pulmonary vessel by a thrombus

Epidemiology

  • Pulmonary embolism (PE) is seen more frequently in adults and tends to occur in postsurgical situations, especially when patients have been bedridden. Two patterns are described in children, classic thromboembolic PE (TE-PE) and in situ pulmonary artery thrombosis (ISPAT).
  • Mean age for TE-PE in children is 14.9 years and 51% of cases are male.
  • ~10% of adults who present with an acute PE die within 1 hour of onset.
  • Increasing incidence is secondary to increased central catheter use.
  • Mortality rate can be as high as 30% if diagnosis is delayed.
  • The incidence of new cases of PE presenting to a large, urban pediatric emergency department was 2.1 cases per 100,000 visits.

Risk Factors

  • In children
    • Presence of a central venous catheter
    • Lack of mobility
    • Congenital heart disease
    • Ventriculoatrial shunt
    • Trauma
    • Solid tumors or leukemia
    • After-surgical procedures (especially reparative intervention for scoliosis repair)
    • Hypercoagulable condition
    • Systemic infection
    • Elevated factor VIII or von Willebrand factor levels
    • Protein C deficiency
    • Factor V Leiden deficiency
    • Protein S deficiency
  • In adults: most commonly due to the presence of a deep vein thrombosis, usually in the legs or pelvis

Pathophysiology

  • Thromboemboli may develop anywhere in the systemic venous system.
  • PE is characterized by the triad of hypoxemia, pulmonary hypertension, and right ventricular failure.
    • Diminished pulmonary perfusion causes a ventilation–perfusion mismatch, resulting in hypoxemia.
    • Hyperventilation occurs secondary to stimulation of proprioceptors in the lung.
    • Hypercapnia is seen with severe occlusion of the pulmonary artery (often not seen with smaller emboli).
  • Pulmonary infarction is uncommon due to the presence of collateral pulmonary and bronchial arteries along with the airways providing additional sources of oxygen to the tissues.
  • Death occurs with 85% obstruction of the pulmonary artery.

Etiology

Blood clots appear as a result of deep vein thrombosis or other disease states.

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Citation

Cabana, Michael D., editor. "Pulmonary Embolism." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617787/all/Pulmonary_Embolism.
Pulmonary Embolism. In: Cabana MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617787/all/Pulmonary_Embolism. Accessed April 24, 2019.
Pulmonary Embolism. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617787/all/Pulmonary_Embolism
Pulmonary Embolism [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 24]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617787/all/Pulmonary_Embolism.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Pulmonary Embolism ID - 617787 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617787/all/Pulmonary_Embolism PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -