Author: Tarannum Rehal
Pulmonary embolism, also known as PE, occurs when a blood clot develops in a blood vessel (typically an artery or vein) and then travels to an artery within the lungs causing blockage of the blood flow. Evidently, this condition is likely to be fatal if left undiagnosed and untreated. The blood clots are most commonly formed in the deep veins of the legs, which refers to a condition called deep vein thrombosis and are typically due to compression of the blood vessel, formation of air bubbles, result of a tumor, or are part of the fat from the marrow of a broken bone. Anyone may develop blood clots and thus, the possibility of suffering from pulmonary embolism. Individuals with certain heart disease, cancers, kidney disease, obesity, as well as individuals recovering from surgery are at a higher risk of developing pulmonary embolism. However, though rare compared to adults, an increasing rate of pulmonary embolism has been observed in young children, including newborn babies.
Pulmonary embolism contributes to increased statistics of child morbidity as this condition is often unrecognized in this population, which leads to inaccurate and late diagnoses. It has also presented an increasing connection to congenital (heart) diseases and certain cancers compared to infections at birth or through development. This condition is also nearly twice as common in children of colour (black) as opposed to white children. However, as this condition is often unnoticed and misdiagnosed in pediatrics, it is likely that the statistics are significantly lower than they actually are.
The most common signs and symptoms of PE include shortness of breath, chest pain, cough, irregular heartbeat, dizziness, excessive sweating, fever, pain or swelling in the leg in which the blood clot originated, and cyanosis. As adults are evidently more vocal in expressing their suffering, these symptoms are easier to link back to PE compared to in children, which contributes to the misdiagnosis in the pediatric population. In children, these symptoms are often related back to pneumonia or a malignant tumor.
As a result of misdiagnosis, a high index of suspicion of PE in children is maintained. Various tests and scans are performed on patients and suspected patients. However, the drawback is that some of these tests and imaging techniques observe other diseases that manifest similar symptoms and internal conditions. For example, ventilation/perfusion (V/Q) scans are a safe and easily scanning technique employed in pediatric PE diagnosis, however, similar scans may also be seen in individuals who have pneumonia, sickle-cell disease, and arterial stenosis. To reduce misdiagnosis, the imaging is conducted in eight different anatomical positions for a relatively complete view of the lungs. However, the methodology of these imaging techniques is not ideal for children due to the need for active aerosol inhalation, which may actually result in irritation. Magnetic resonance imaging (MRI), magnetic resonance pulmonary angiography (MRPA), CT pulmonary angiography (CTPA), and pulmonary angiography are other imaging techniques used in the diagnosis for PE in adults. However, their reliability, invasiveness, expense, and ionizing radiation pose disadvantages for pediatric diagnosis.
The short-term and long-term effects of PE have been studied in adults but not as extensively in the pediatric population. These effects include recurrence of PE, morbidity, pulmonary and vascular disease, and other defects. Ongoing research aims to determine effective diagnostic techniques for the pediatric population, though CT angiography is typically employed currently. This technique involves an intravenous injection with a specific dye into particular blood vessels which are then analyzed with a CT scan. As it can be an invasive technique, general anesthesia is commonly used for younger children.
The aim is to identify signs and symptoms as soon as they manifest and diagnose them appropriately and educate parents on pediatric pulmonary embolism so they may better recognize its signs and prevent this condition from developing in the first place since children are so vulnerable to such conditions as they navigate through the world after birth.
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