Department of Pediatrics, Rivers State University, Port Harcourt, Nigeria.
Department of Radiology, Rivers State University Teaching Hospital, Port Harcourt, Nigeria.
Medicine (Baltimore). 2024 Sep 13;103(37):e39503. doi: 10.1097/MD.0000000000039503.
Pulmonary embolism is a rare life-threatening condition in pediatric populations. Diagnosis is often challenging in resource-constrained settings suffering chronic shortages of specialist and diagnostic services. We report the prompt recognition and challenging management of pulmonary embolism in an adolescent presenting to a private specialist hospital in a resource-constrained country. Although, majority of the Nigerian population utilize private healthcare, most centers are not equipped with sophisticated radiological and advanced laboratory services. These services were outsourced to a recently equipped state-owned tertiary hospital.
We present the case of a 14-year-old female who presented to the hospital with complaints of sharp left-sided chest pain and palpitations of 1 week duration. She was well until a week prior to the presentation when she noticed a sharp pain in her chest on waking up that was severe enough to make her cry. She was also felt her heart racing fast. The chest pain seemed to have subsided until a day prior to hospital presentation when she had a repeat episode following dance practice, necessitating her coming to the hospital.On examination at presentation, she was in painful distress, mildly pale, anicteric, acyanosed, with no peripheral edema. She had tachycardia, and her pulse was full volume, regularly irregular, and synchronous with peripheral pulses. Her blood pressure was 110/70 mmHg, and her apex beat was at the 5th left intercostal space, mid-clavicular line, non-heaving. Heart sounds 1 and 2 only were heard. The diagnosis was confirmed using a D-dimer assay, Echocardiography, and Computerized tomography pulmonary angiogram.
A diagnosis of pulmonary embolism was made.
The patient received pharmacological management using low molecular weight heparin, recombinant tissue plasminogen activator, and direct factor Xa inhibitor to manage and resolve the embolism.
The embolus was resolved after months of anticoagulant therapy, as confirmed by serial echocardiography.
The case highlights the need for low-resource settings to address diagnostic limitations and emphasizes the importance of a multidisciplinary approach to managing pulmonary embolism cases. It also adds to the growing evidence of the effective role of pharmacological therapy in the management of pulmonary embolism.
肺栓塞是儿科人群中罕见的危及生命的病症。在资源有限的环境中，由于专家和诊断服务长期短缺，诊断常常具有挑战性。我们报告了在资源有限的国家的一家私立专科医院就诊的一名青少年肺栓塞的快速诊断和治疗。尽管尼日利亚大多数人都利用私立医疗保健，但大多数中心都没有配备复杂的放射学和先进的实验室服务。这些服务外包给最近配备的国有三级医院。
我们报告了一名 14 岁女性患者的病例，她因左侧胸痛和心悸 1 周就诊。她之前身体良好，直到就诊前一周，她醒来时感到胸口剧痛，疼得她哭了起来，还感到心跳很快。胸痛似乎有所缓解，直到就诊前一天，她在舞蹈练习后再次出现这种情况，需要来医院就诊。就诊时，她疼痛难忍，面色略显苍白，无黄疸，无发绀，无外周水肿。她有心悸，脉搏饱满，节律不规则，与周围脉搏同步。她的血压为 110/70mmHg，心尖搏动位于第 5 肋间隙左锁骨中线内侧。仅能听到心音 1 和 2。诊断通过 D-二聚体检测、超声心动图和计算机断层肺动脉造影得到确认。
肺栓塞。
患者接受了低分子肝素、重组组织型纤溶酶原激活物和直接因子 Xa 抑制剂的药物治疗，以管理和解决栓塞。
经过数月的抗凝治疗，栓塞得到解决，通过连续的超声心动图得到确认。
该病例强调了资源有限的环境需要解决诊断局限性的问题，并强调了多学科方法在肺栓塞病例管理中的重要性。它也增加了药理学治疗在肺栓塞管理中有效作用的证据。
