Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ Acute onset dyspnea and tachypnea Evidence of embolism on chest imaging Rare in children Etiologies include Sickle cell anemia (as part of the acute chest syndrome) Malignancy Rheumatic fever Infective endocarditis Bone fracture Dehydration Polycythemia Nephrotic syndrome Atrial fibrillation A majority of children with pulmonary emboli referred for hematology evaluation have coagulation regulatory protein abnormalities and antiphospholipid antibodies In children, tumor emboli are a more common cause of massive pulmonary embolism than embolization from a lower extremity deep venous thrombosis +++ Clinical Findings ++ Acute onset of dyspnea and tachypnea Heart palpitations, pleuritic chest pain, and a sense of impending doom may be reported Hemoptysis is rare but may occur along with splinting, cyanosis, and tachycardia Massive emboli may be present with syncope and cardiac arrhythmias Mild hypoxemia, rales, focal wheezing, or a pleural friction rub may be found +++ Diagnosis ++ Radiography May be normal However, a peripheral infiltrate, small pleural effusion, or elevated hemidiaphragm can be present If the emboli are massive, differential blood flow and pulmonary artery enlargement may be appreciated Electrocardiogram is usually normal unless the pulmonary embolus is massive Echocardiography is useful in detecting the presence of a large embolus in the great vessels A negative D-dimer has a more than 95% negative predictive value for an embolus, but has poor specificity Ventilation-perfusion scans show localized areas of ventilation without perfusion Spiral CT with contrast may be helpful Pulmonary angiography is the gold standard Coagulation studies are abnormal in up to 70% of pediatric patients +++ Treatment ++ Supplemental oxygen Anticoagulation: heparin therapy to maintain an activated partial thromboplastin time of > 1.5 times the control value for the first 24 hours Urokinase or tissue plasminogen activator Can be used to help dissolve the embolus Should be followed by warfarin therapy for at least 6 weeks with an international normalized ratio (INR) > 2 Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.