Pediatric Pulmonary Embolism

  • Etiology: Usually arises from migration of deep venous thrombosis into the pulmonary artery
  • Imaging CXR: Peripheral wedge-shaped opacity representing pulmonary embolism and infarct (Hampton’s hump)
  • Imaging V/Q scan: Normal ventilation with lack of perfusion (V/Q mismatch)
  • Imaging CT:
    — Intraluminal filling defects in the pulmonary artery which if large enough may result in peripheral pleural-based wedge shaped opacities
    — More common in lower lobes than upper lobes
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Uncommon cause of chest pain
    — Risk factors are indwelling central line, malignancy, hypercoagulable states such as use of oral contraceptives, immobility, dehydration, sepsis, renal disease, surgery, trauma

Radiology Cases of Pulmonary Embolism

CXR, VQ scan, angiogram of pulmonary embolism / pulmonary embolus / PE
CXR AP (above) shows a large wedge shaped infiltrate in the right lower lobe and a right pleural effusion. Anterior ventilation image (middle left) from a V/Q scan shows normal ventilation to both lungs while the anterior perfusion image (middle right) shows no perfusion to the right lung and normal perfusion to the left lung. AP image from a pulmonary angiogram (below) shows a large filling defect due to thrombus in the right pulmonary artery and near complete lack of blood flow to the right lung.
CT of bilateral pulmonary embolus
Axial (above) and coronal (below) CT with contrast of the chest shows large and lengthy low density intraluminal filling defects in the left and right pulmonary arteries.
CXR and V/Q scan and CT of pulmonary embolism
CXR AP (above left) shows dextrocardia and an infiltrate in the left lower lobe. Anterior ventilation image from a V/Q scan (above middle) shows near-normal ventilation to the lungs. Posterior perfusion image from a V/Q scan (above left) shows markedly decreased perfusion to the left lung, with 95% of the perfusion going to the right lung. Coronal CT with contrast of the chest (below left) shows a massively enlarged left pulmonary artery with thrombus in its left lower lobe branches. Axial images (below middle and below right) show multiple peripheral infarcts in the left lower lobe.