Pediatric Intensive Care Unit of Instituto da Criança, Hospital das Clínicas, University of São Paulo, Avenida Dr. Enéas de Carvalho Aguiar, 647, CEP 05403000, São Paulo, SP, Brazil.
Department of Pediatrics of Instituto da Criança, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Pediatr Radiol. 2022 Jan;52(1):144-147. doi: 10.1007/s00247-021-05199-1. Epub 2021 Sep 24.
We report a case of pulmonary thrombosis in a teenager during a hypercoagulable state associated with COVID-19 (coronavirus disease 2019) caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). A condition rare in children and adolescents, pulmonary thrombosis underdiagnosis likely increases morbidity and mortality. A pulmonary thrombosis diagnosis requires a high level of suspicion and relies on the combination of clinical presentation, D-dimer elevation, and computed tomography (CT) pulmonary angiography or ventilation/perfusion scans, imaging techniques that are difficult to perform. Electrical impedance tomography (EIT) has gained attention, as it provides real-time ventilation distribution analysis. In addition, lung pulsatility images can be obtained through this technique using electrocardiogram gating to filter out ventilation. In this case report, the reduced EIT pulsatility corresponded to the perfusion defect found on the CT scan, information that was obtained at the bedside without radiation or contrast exposure.
我们报告了一例 COVID-19（2019 年冠状病毒病）相关的 SARS-CoV-2（严重急性呼吸综合征冠状病毒 2）引起的高凝状态青少年肺血栓形成。这种情况在儿童和青少年中较为罕见，肺血栓形成的诊断不足可能会增加发病率和死亡率。肺血栓形成的诊断需要高度怀疑，并依赖于临床表现、D-二聚体升高以及计算机断层扫描（CT）肺动脉造影或通气/灌注扫描的结合，这些影像学技术难以进行。电阻抗断层成像（EIT）受到了关注，因为它提供了实时的通气分布分析。此外，通过该技术使用心电图门控可以获得肺搏动图像，以过滤通气。在本病例报告中，EIT 搏动性降低与 CT 扫描发现的灌注缺陷相对应，这些信息是在床边获得的，没有辐射或对比剂暴露。
