Complications of Pulmonary Embolism in a Pediatric Patient (JACC Case Reports February 2025)-Article: Complications of Pulmonary Embolism in a Pediatric Patient

Article: Complications of Pulmonary Embolism in a Pediatric Patient

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This case report details a complex medical scenario involving a 16-year-old boy who presented with severe pulmonary embolism (PE) complicated by right ventricular failure, requiring emergent surgical embolectomy and extracorporeal membrane oxygenation (ECMO). The patient's condition was further complicated by a subsequent diagnosis of catastrophic antiphospholipid syndrome (CAPS) and the development of pneumatoceles leading to tension pneumothoraxes.<br /><br />Initially presenting with respiratory distress and fatigue attributed to a presumed upper respiratory infection, the patient was later suspected of PE after experiencing specific alarming symptoms such as tachypnea and tachycardia. Imaging studies confirmed the presence of substantial bilateral pulmonary artery thrombi. Due to high-risk PE with impending cardiovascular collapse, the patient underwent a surgical embolectomy as suggested by the hospital's Pulmonary Embolism Response Team, consisting of various multidisciplinary specialists.<br /><br />Post-surgery, despite some right ventricular dysfunction evidenced by imaging, there was improvement following ECMO support. The suspected CAPS necessitated immunosuppressive treatment with steroids, plasma exchange, and rituximab. Surviving this critical phase, the patient later faced respiratory setbacks from necrotizing pneumonia and pneumothoraxes, attributed to pulmonary infarctions. Conservative treatment with chest tubes was adopted, leading to gradual recovery. The patient was able to attend school full-time following discharge.<br /><br />The case emphasizes the necessity of multidisciplinary collaboration in pediatric critical care, highlighting specific challenges in diagnosis and treatment when managing rare and severe conditions like pediatric PE and CAPS. It also notes the growing rates of PE in children and the long-term impacts such conditions can have on quality of life and physical capabilities, as even after treatment, the patient exhibited reduced exercise tolerance. This underscores the importance of ongoing monitoring and management to address potential chronic sequelae.

Keywords

pulmonary embolism

right ventricular failure

extracorporeal membrane oxygenation

catastrophic antiphospholipid syndrome

pneumatoceles

tension pneumothoraxes

surgical embolectomy

pediatric critical care

multidisciplinary collaboration

chronic sequelae