Subscribe to RSS
DOI: 10.1055/s-0031-1297168
Pulmonary Embolism in Children
Publication History
Publication Date:
20 December 2011 (online)

ABSTRACT
Pulmonary embolism (PE) has long been described in children. Nevertheless, most of the algorithms applied to patients within this age range, from diagnosis to therapy, have been adapted from adult protocols. This article reviews the progresses that occurred to PE in children placing them in historical perspective with the key events relevant to PE in adults. A brief summary of the initial reports encountered in the pediatric literature followed by key conclusions drawn from national database reports characterizing its epidemiology in children is highlighted. Additionally, a section with the diagnostic tools pertaining to children is included. Closing remarks encompass commentaries related to therapy and outcomes, reflecting on current knowledge gaps related to PE in children.
KEYWORDS
Anticoagulation - children - deep vein thrombosis - pulmonary embolism - pulmonary hypertension
REFERENCES
- 1 WHO .Health statistics and health information systems. [Cited 2011 April 8]; Available from: http://www.who.int/healthinfo/en/
Reference Ris Wihthout Link
- 2
Silverstein M D, Heit J A, Mohr D N, Petterson T M, O'Fallon W M, Melton III L J.
Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year
population-based study.
Arch Intern Med.
1998;
158
(6)
585-593
Reference Ris Wihthout Link
- 3 Billard C. A Treatise on the Disease of Infants, Founded on Recent Clinical Observations and
Investigations in Pathological Anatomy Made at the Hospice des Énfants-Trouves, with
a Dissertation on the Viability of the Child. J & H Langley ed. 1839
Reference Ris Wihthout Link
- 4
Löschner .
Phlebitis venae cruralis sinistrae, peri- et myocarditis, embolis et oedema pulmonum.
Jahrb f Kinderh.
1861;
4
66
Reference Ris Wihthout Link
- 5
Stevenson G F, Stevenson F L.
Pulmonary embolism in childhood.
J Pediatr.
1949;
34
(1)
62-69
Reference Ris Wihthout Link
- 6
Coon W W, Coller F A.
Some epidemiologic considerations of thromboembolism.
Surg Gynecol Obstet.
1959;
109
487-501
Reference Ris Wihthout Link
- 7
Buck J R, Connors R H, Coon W W, Weintraub W H, Wesley J R, Coran A G.
Pulmonary embolism in children.
J Pediatr Surg.
1981;
16
(3)
385-391
Reference Ris Wihthout Link
- 8
Byard R W, Cutz E.
Sudden and unexpected death in infancy and childhood due to pulmonary thromboembolism.
An autopsy study.
Arch Pathol Lab Med.
1990;
114
(2)
142-144
Reference Ris Wihthout Link
- 9
Schein C J, Rifkin H, Hurwitt E S, Lebendiger A.
The clinical and surgical aspects of chronic pulmonary artery thrombosis.
AMA Arch Intern Med.
1958;
101
(3)
592-605
Reference Ris Wihthout Link
- 10
Wood K E.
Major pulmonary embolism: review of a pathophysiologic approach to the golden hour
of hemodynamically significant pulmonary embolism.
Chest.
2002;
121
(3)
877-905
Reference Ris Wihthout Link
- 11
Elliott C G.
Pulmonary physiology during pulmonary embolism.
Chest.
1992;
101
(4, Suppl)
163S-171S
Reference Ris Wihthout Link
- 12
Benotti J R.
Pulmonary angiography in the diagnosis of pulmonary embolism.
Herz.
1989;
14
(2)
115-125
Reference Ris Wihthout Link
- 13
Kröger K, Moerchel Ch, Moysidis T, Santosa F.
Incidence rate of pulmonary embolism in Germany: data from the federal statistical
office.
J Thromb Thrombolysis.
2010;
29
(3)
349-353
Reference Ris Wihthout Link
- 14
Jones D R, Macintyre I M.
Venous thromboembolism in infancy and childhood.
Arch Dis Child.
1975;
50
(2)
153-155
Reference Ris Wihthout Link
- 15
Schmidt B, Andrew M.
Neonatal thrombosis: report of a prospective Canadian and international registry.
Pediatrics.
1995;
96
(5 Pt 1)
939-943
Reference Ris Wihthout Link
- 16
Nowak-Göttl U, von Kries R, Göbel U.
Neonatal symptomatic thromboembolism in Germany: two year survey.
Arch Dis Child Fetal Neonatal Ed.
1997;
76
(3)
F163-F167
Reference Ris Wihthout Link
- 17
van Ommen C H, Heijboer H, Büller H R, Hirasing R A, Heijmans H S, Peters M.
Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands.
J Pediatr.
2001;
139
(5)
676-681
Reference Ris Wihthout Link
- 18
Kuhle S, Massicotte P, Chan A et al..
Systemic thromboembolism in children. Data from the 1–800-NO-CLOTS Consultation Service.
Thromb Haemost.
2004;
92
(4)
722-728
Reference Ris Wihthout Link
- 19
Andrew M, David M, Adams M et al..
Venous thromboembolic complications (VTE) in children: first analyses of the Canadian
Registry of VTE.
Blood.
1994;
83
(5)
1251-1257
Reference Ris Wihthout Link
- 20
Gibson BES, Chalmers E A, Bolton-Maggs P, Henderson D J, Boshkov R L.
Thromboembolism in childhood: a prospective 2-year study in the United Kingdom (interim:
Feb 2001-Feb 2003).
J Thromb Haemost.
2003;
1
(Supp 1)
Reference Ris Wihthout Link
- 21
Stein P D, Kayali F, Olson R E.
Incidence of venous thromboembolism in infants and children: data from the National
Hospital Discharge Survey.
J Pediatr.
2004;
145
(4)
563-565
Reference Ris Wihthout Link
- 22
Biss T T, Brandão L R, Kahr W H, Chan A K, Williams S.
Clinical features and outcome of pulmonary embolism in children.
Br J Haematol.
2008;
142
(5)
808-818
Reference Ris Wihthout Link
- 23
Raffini L, Huang Y S, Witmer C, Feudtner C.
Dramatic increase in venous thromboembolism in children's hospitals in the United
States from 2001 to 2007.
Pediatrics.
2009;
124
(4)
1001-1008
Reference Ris Wihthout Link
- 24
David M, Andrew M.
Venous thromboembolic complications in children.
J Pediatr.
1993;
123
(3)
337-346
Reference Ris Wihthout Link
- 25
Kjellin I B, Boechat M I, Vinuela F, Westra S J, Duckwiler G R.
Pulmonary emboli following therapeutic embolization of cerebral arteriovenous malformations
in children.
Pediatr Radiol.
2000;
30
(4)
279-283
Reference Ris Wihthout Link
- 26
Farrell A G, Parikh S R, Darragh R K, Girod D A.
Retrieval of “old” foreign bodies from the cardiovascular system in children.
Cathet Cardiovasc Diagn.
1998;
44
(2)
212-216, discussion 217
Reference Ris Wihthout Link
- 27
Soares F A.
Fatal pulmonary tumor embolism caused by chondroblastic osteosarcoma.
Arch Pathol Lab Med.
2000;
124
(5)
661
Reference Ris Wihthout Link
- 28
Victoria T, Mong A, Altes T et al..
Evaluation of pulmonary embolism in a pediatric population with high clinical suspicion.
Pediatr Radiol.
2009;
39
(1)
35-41
Reference Ris Wihthout Link
- 29
Bernstein D, Coupey S, Schonberg S K.
Pulmonary embolism in adolescents.
Am J Dis Child.
1986;
140
(7)
667-671
Reference Ris Wihthout Link
- 30
Rajpurkar M, Warrier I, Chitlur M et al..
Pulmonary embolism-experience at a single children's hospital.
Thromb Res.
2007;
119
(6)
699-703
Reference Ris Wihthout Link
- 31
Tavil B, Kuskonmaz B, Kiper N, Cetin M, Gumruk F, Gurgey A.
Pulmonary thromboembolism in childhood: a single-center experience from Turkey.
Heart Lung.
2009;
38
(1)
56-65
Reference Ris Wihthout Link
- 32
Wells P S, Anderson D R, Rodger M et al..
Derivation of a simple clinical model to categorize patients probability of pulmonary
embolism: increasing the models utility with the SimpliRED D-dimer.
Thromb Haemost.
2000;
83
(3)
416-420
Reference Ris Wihthout Link
- 33
Biss T T, Brandão L R, Kahr W H, Chan A K, Williams S.
Clinical probability score and D-dimer estimation lack utility in the diagnosis of
childhood pulmonary embolism.
J Thromb Haemost.
2009;
7
(10)
1633-1638
Reference Ris Wihthout Link
- 34
Mcginn S, White P D.
Acute cor pulmonale resulting from pulmonary embolism.
JAMA.
1935;
104
1473-1479
Reference Ris Wihthout Link
- 35
Rodger M, Makropoulos D, Turek M et al..
Diagnostic value of the electrocardiogram in suspected pulmonary embolism.
Am J Cardiol.
2000;
86
(7)
807-809, A10
Reference Ris Wihthout Link
- 36
The PIOPED Investigators .
Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the
prospective investigation of pulmonary embolism diagnosis (PIOPED).
JAMA.
1990;
263
(20)
2753-2759
Reference Ris Wihthout Link
- 37
Worsley D F, Alavi A, Aronchick J M, Chen J T, Greenspan R H, Ravin C E.
Chest radiographic findings in patients with acute pulmonary embolism: observations
from the PIOPED Study.
Radiology.
1993;
189
(1)
133-136
Reference Ris Wihthout Link
- 38
Novelline R A, Baltarowich O H, Athanasoulis C A, Waltman A C, Greenfield A J, McKusick K A.
The clinical course of patients with suspected pulmonary embolism and a negative pulmonary
arteriogram.
Radiology.
1978;
126
(3)
561-567
Reference Ris Wihthout Link
- 39
van Beek E J, Reekers J A, Batchelor D A, Brandjes D P, Büller H R.
Feasibility, safety and clinical utility of angiography in patients with suspected
pulmonary embolism.
Eur Radiol.
1996;
6
(4)
415-419
Reference Ris Wihthout Link
- 40
van Beek E J, Brouwerst E M, Song B, Stein P D, Oudkerk M.
Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary
embolism—a critical review.
Clin Radiol.
2001;
56
(10)
838-842
Reference Ris Wihthout Link
- 41
Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on
Pulmonary Embolism, European Society of Cardiology.
Eur Heart J.
2000;
21
(16)
1301-1336
Reference Ris Wihthout Link
- 42
Anderson D R, Kahn S R, Rodger M A et al..
Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning
in patients with suspected pulmonary embolism: a randomized controlled trial.
JAMA.
2007;
298
(23)
2743-2753
Reference Ris Wihthout Link
- 43
Schoepf U J, Kucher N, Kipfmueller F, Quiroz R, Costello P, Goldhaber S Z.
Right ventricular enlargement on chest computed tomography: a predictor of early death
in acute pulmonary embolism.
Circulation.
2004;
110
(20)
3276-3280
Reference Ris Wihthout Link
- 44
Van Strijen M J, De Monye W, Kieft G J, Pattynama P M, Prins M H, Huisman M V.
Accuracy of single-detector spiral CT in the diagnosis of pulmonary embolism: a prospective
multicenter cohort study of consecutive patients with abnormal perfusion scintigraphy.
J Thromb Haemost.
2005;
3
(1)
17-25
Reference Ris Wihthout Link
- 45
Coche E, Verschuren F, Keyeux A et al..
Diagnosis of acute pulmonary embolism in outpatients: comparison of thin-collimation
multi-detector row spiral CT and planar ventilation-perfusion scintigraphy.
Radiology.
2003;
229
(3)
757-765
Reference Ris Wihthout Link
- 46
Winer-Muram H T, Rydberg J, Johnson M S et al..
Suspected acute pulmonary embolism: evaluation with multi-detector row CT versus digital
subtraction pulmonary arteriography.
Radiology.
2004;
233
(3)
806-815
Reference Ris Wihthout Link
- 47
Stein P D, Fowler S E, Goodman L R PIOPED II Investigators et al.
Multidetector computed tomography for acute pulmonary embolism.
N Engl J Med.
2006;
354
(22)
2317-2327
Reference Ris Wihthout Link
- 48
Le Gal G, Righini M, Parent F, van Strijen M, Couturaud F.
Diagnosis and management of subsegmental pulmonary embolism.
J Thromb Haemost.
2006;
4
(4)
724-731
Reference Ris Wihthout Link
- 49
Stein P D, Chenevert T L, Fowler S E PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) Investigators et al.
Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter
prospective study (PIOPED III).
Ann Intern Med.
2010;
152
(7)
434-443, W142–3
Reference Ris Wihthout Link
- 50
Smith S B, Geske J B, Maguire J M, Zane N A, Carter R E, Morgenthaler T I.
Early anticoagulation is associated with reduced mortality for acute pulmonary embolism.
Chest.
2010;
137
(6)
1382-1390
Reference Ris Wihthout Link
- 51
Barritt D W, Jordan S C.
Anticoagulant drugs in the treatment of pulmonary embolism. A controlled trial.
Lancet.
1960;
1
(7138)
1309-1312
Reference Ris Wihthout Link
- 52
Van Ommen C H, Peters M.
Acute pulmonary embolism in childhood.
Thromb Res.
2006;
118
(1)
13-25
Reference Ris Wihthout Link
- 53
Monagle P, Chalmers E, Chan A American College of Chest Physicians et al.
Antithrombotic therapy in neonates and children: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines (8th Edition).
Chest.
2008;
133
(6, Suppl)
887S-968S
Reference Ris Wihthout Link
- 54
Dolovich L R, Ginsberg J S, Douketis J D, Holbrook A M, Cheah G.
A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin
in the treatment of venous thromboembolism: examining some unanswered questions regarding
location of treatment, product type, and dosing frequency.
Arch Intern Med.
2000;
160
(2)
181-188
Reference Ris Wihthout Link
- 55
Malhotra S, Karan R S, Bhargava V K et al..
A meta-analysis of controlled clinical trials comparing low-molecular weight heparins
with unfractionated heparin in unstable angina.
Indian Heart J.
2001;
53
(2)
197-202
Reference Ris Wihthout Link
- 56
Massicotte P, Julian J A, Gent M REVIVE Study Group et al.
An open-label randomized controlled trial of low molecular weight heparin compared
to heparin and coumadin for the treatment of venous thromboembolic events in children:
the REVIVE trial.
Thromb Res.
2003;
109
(2–3)
85-92
Reference Ris Wihthout Link
- 57
Agnelli G, Becattini C.
Acute pulmonary embolism.
N Engl J Med.
2010;
363
(3)
266-274
Reference Ris Wihthout Link
- 58
Come P C.
Echocardiographic evaluation of pulmonary embolism and its response to therapeutic
interventions.
Chest.
1992;
101
(4, Suppl)
151S-162S
Reference Ris Wihthout Link
- 59
Albisetti M.
Thrombolytic therapy in children.
Thromb Res.
2006;
118
(1)
95-105
Reference Ris Wihthout Link
- 60
Zenz W, Arlt F, Sodia S, Berghold A.
Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the
literature of the last thirty years.
Semin Thromb Hemost.
1997;
23
(3)
321-332
Reference Ris Wihthout Link
- 61
Raffini L.
Thrombolysis for intravascular thrombosis in neonates and children.
Curr Opin Pediatr.
2009;
21
(1)
9-14
Reference Ris Wihthout Link
- 62
Hoffmeister H M, Szabo S, Helber U, Seipel L.
The thrombolytic paradox.
Thromb Res.
2001;
103
(Suppl 1)
S51-S55
Reference Ris Wihthout Link
- 63
Jean N, Labombarda F, De La Gastine G, Raisky O, Boudjemline Y.
Successful pulmonary embolectomy in a 4-year-old girl with antithrombin III deficiency.
Pediatr Cardiol.
2010;
31
(5)
711-713
Reference Ris Wihthout Link
- 64
Robinson A, Fellows K E, Bridges N D, Rome J J.
Effectiveness of pharmacomechanical thrombolysis in infants and children.
Am J Cardiol.
2001;
87
(4)
496-499, A8
Reference Ris Wihthout Link
- 65
van Loon R L, Roofthooft M T, van Osch-Gevers M et al..
Clinical characterization of pediatric pulmonary hypertension: complex presentation
and diagnosis.
J Pediatr.
2009;
155
(2)
176-182, e1
Reference Ris Wihthout Link
- 66
Fedullo P F, Auger W R, Kerr K M, Rubin L J.
Chronic thromboembolic pulmonary hypertension.
N Engl J Med.
2001;
345
(20)
1465-1472
Reference Ris Wihthout Link
- 67
Pengo V, Lensing A W, Prins M H Thromboembolic Pulmonary Hypertension Study Group et al.
Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism.
N Engl J Med.
2004;
350
(22)
2257-2264
Reference Ris Wihthout Link
- 68
Binder L, Pieske B, Olschewski M et al..
N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography
for risk stratification of acute pulmonary embolism.
Circulation.
2005;
112
(11)
1573-1579
Reference Ris Wihthout Link
Leonardo R. BrandãoM.D.
The Hospital for Sick Children
555 University Avenue, Black Wing, Room 10412, Toronto, ON M5G 1X8, Canada
Email: leonardo.brandao@sickkids.ca