Acute Pulmonary Embolism in a Teenage Female – A Case Report

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Thrombophilia represents a tendency towards excessive blood clotting and the subsequent development of venous thromboembolism (VTE). VTE is a rare condition in children that comprises both deep venous thrombosis (DVT) and pulmonary embolism (PE). This paper reports the case of a 16-year-old girl, admitted to the Pediatrics Clinic No. 1, Tîrgu Mureș, Romania, for dyspnea, chest pain and loss of consciousness. Her personal history showed that she had had two orthopedic surgical interventions in infancy, two pregnancies, one spontaneous miscarriage and a recent caesarian section at 20 weeks of gestation for premature detachment of a normally positioned placenta associated with a deceased fetus. Laboratory tests showed increased levels of D-dimers. Angio-Computed Tomography (Angio-CT) showed multiple filling defects in both pulmonary arteries, establishing the diagnosis of PE. The laboratory tests were undertaken to assist in the diagnoses of a possible thrombophilia underlined a low level of antithrombin III. Antiphospholipid syndrome was ruled out and genetic tests revealed no specific mutation. Anticoagulant therapy was initiated with unfractionated heparin and afterwards subcutaneously low molecular heparin was prescribed for three months. Later it has been changed to oral therapy with acenocoumarol. The patient was discharged in good general status with the recommendation of life-long anticoagulation therapy. Thrombophilia is a significant risk factor for PE, and it must be ruled out in all cases of repeated miscarriage.

1. Abu-Heija A. Thrombophilia and Recurrent Pregnancy Loss. Is heparin still the drug of choice?. Sultan Qaboos University Med J. 2014;14:26-36.

2. Adetola FLJ, Maggio L, Romero ST. Prenatal Screening for Thrombophilias Indications and Controversies, an Update. Clin Lab Med. 2016;36:421-34.

3. Armean I, Duicu C, Aldea C, Melit LE. Serratia marcescens Sepsis in a Child with Deep Venous Thrombosis – A Case Report. J Crit Care Med (Targu Mures). 2018;4:29-33.

4. Duicu C, Bucur G, Simu I, Marginean O. Deep Venous Thrombosis Associated With Inferior Vena Cava Abnormalities And Hypoplastic Kidney In Siblings. Acta Medica Marisiensis. 2016;62:266-268.

5. Meliț LE, Mărginean CO, Georgescu A, Duicu C. Complications of sepsis in infant. A case report. J Crit Care Med (Targu Mures). 2016;2:96-9.

6. Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of Pulmonary Embolism An Update. J Am Coll Cardiol. 2016;67:976-89.

7. Raskob GE, Angchaisuksiri P, Blanco AN, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34:2363-71.

8. Meyer G. Effective diagnosis and treatment of pulmonary embolism: Improving patient outcomes. Arch Cardiovas Dis. 2014;107:406-14.

9. Tang CX, Schoepf UJ, Chowdhury SM, et al. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism. Pediatr Radiol. 2015;45:1431–39.

10. Agha SB, Sturm JJ, Simon HK, Hirsh AD. Pulmonary Embolism in the Pediatric Emergency Department. Pediatrics. 2013;132:663-7.

11. Ommen VCH, Heijboer H, Buller HR, et al. Venous thromboembolism in childhood: a prospective two year registry in the Netherlands. J Pediatr. 2001;139:676-81.

12. Coriu LU, Talmaci R, Uscatescu V, et al. Hereditary Thrombophilia and thrombotic events in pregnancy: single-center experience. J Med Life. 2014;7:567-71.

13. Martinelli I, Battaglioli T, De Stefano V, el al. The risk of first venous thromboembolism during pregnancy and puerperium in double heterozygotes for factor V Leiden and prothrombin G20210A. Journal Thromb Haemost. 2007;6:494-8.

14. Bates SM, Greer IA, Middeldorp S. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic therapy and prevention of thrombosis. 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:691-736.

15. Conti E, Zezza L, Ralli E, et al. Pulmonary embolism in pregnancy. Journal Thromb Thrombolysis. 2014;37:251-70.

16. Cahill AG, Stout MJ, Macones GA, et al. Diagnosing pulmonary embolism in pregnancy using computed-tomographic angiography or ventilation-perfusion. Obstet Gynecol. 2009;114:124-9.

17. Simcox EL, Ormesher L, Tower C, Greer IA. Thrombophilia and Pregnancy Complications. Int J Mol Sci. 2015;16:28418-28.

18. Martínez-Zamora MA, Cervera R, Balasch J. Recurrent Miscarriage, Antiphospholipid Antibodies and the Risk of Thromboembolic Disease. Clinic Rev Allerg Immunol. 2012;43:265-74.

19. Aksoy M, Tek I, Karabulut H, Berker B, Soylemez F. The role of thrombofilia related to Factor V Leiden and Factor II G20210A mutations in recurrent abortions. J Pak Med Assoc. 2005;55:104-8.

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