Zhao Dandong, Xiong Qiang, Lv Ying, Ting Gong, Lu Shuya, Luo Jian, Xie Xiaohong, Zhang Mingxiang, He Linli, Yang Tian, Tian Daiyin
Department of Respiratory Medicine Children's Hospital of Chongqing Medical University National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity Chongqing China.
Department of Hepatobiliary Surgery Children's Hospital of Chongqing Medical University National Clinical Research Center for Child Health and Disorders Ministry of Education Key Laboratory of Child Development and Disorders Chongqing Key Laboratory of Pediatrics Chongqing China.
Pediatr Discov. 2024 May 23;3(1):e83. doi: 10.1002/pdi3.83. eCollection 2025 Mar.
Pulmonary embolism (PE) leads to obstruction of pulmonary circulation, resulting in increased pulmonary vascular resistance, elevated pulmonary arterial pressure, and increased right heart load. In severe cases, it can lead to cardiac decompensation and life-threatening conditions. However, clinical studies on PE in children are limited, with many diagnostic and treatment guidelines derived from adult populations. We retrospectively analyzed the clinical manifestations, risk factors, co-morbidity, and outcomes of PE patients admitted to a large children's hospital in southwest China. A total of 24 children with PE participated, 9 boys (37.5%), aged 0.1-14.6, (median: 8.15 years old). Except for two asymptomatic cases, the duration from symptom onset to the diagnosis of PE varied from 2 to 45 days (median: 12 days). Among these children, 13 (54.2%) patients experienced a delayed diagnosis exceeding 10 days. A total of 7 children died from underlying diseases, and no one met the outcome of recurrent PE or PE-related death. Among the 17 survivors, complete resolution of PE was in 11 (64.7%) children, partial resolution who progressed to chronic PE was in 3 (17.7%) children, and no follow-up computed tomography pulmonary angiography was performed in the remaining 3 (17.7%) children. This study revealed that the majority of pediatric PE cases presented with respiratory symptoms, with a considerable proportion initially misdiagnosed as pneumonia, and emphasized the importance of early recognition and appropriate management strategies in improving outcomes for the affected children. Further research is warranted to elucidate the pathophysiology, refine diagnostic algorithms, and establish standardized treatment protocols tailored to the pediatric population.
肺栓塞（PE）会导致肺循环阻塞，从而引起肺血管阻力增加、肺动脉压力升高以及右心负荷加重。在严重情况下，可导致心脏失代偿和危及生命的状况。然而，关于儿童PE的临床研究有限，许多诊断和治疗指南都源自成人患者群体。我们回顾性分析了中国西南部一家大型儿童医院收治的PE患儿的临床表现、危险因素、合并症及治疗结果。共有24例PE患儿参与研究，其中9例为男孩（37.5%），年龄在0.1至14.6岁之间（中位数：8.15岁）。除2例无症状病例外，从症状出现到诊断为PE的时间为2至45天（中位数：12天）。在这些患儿中，13例（54.2%）诊断延迟超过10天。共有7例患儿死于基础疾病，无一例出现复发性PE或PE相关死亡的情况。在17例存活患儿中，11例（64.7%）PE完全缓解，3例（17.7%）部分缓解并进展为慢性PE，其余3例（17.7%）未进行随访胸部CT肺动脉造影检查。本研究表明，大多数儿童PE病例表现为呼吸道症状，相当一部分最初被误诊为肺炎，并强调了早期识别和适当管理策略对改善患儿预后的重要性。有必要进一步开展研究以阐明其病理生理学机制、完善诊断算法并制定针对儿童群体的标准化治疗方案。
