Comparison of Septic and non-septic Pulmonary Embolism episodes in children
2Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
3Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel
4Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
Background: Septic pulmonary embolism (SPE) in children is a rare disease. There are scarce data regarding the clinical and laboratory manifestation of SPE compared with non-septic pulmonary embolism (ns-PE). Furthermore, there are no specific guideline for the management and the follow up of SPE in pediatric patients.
Aim: To compare the clinical course and outcome of children with SPE and ns-PE.
Methods: A retrospective, cohort study of hospitalized children <18 years, during 2005 through 2020, with documented imaging of pulmonary embolism.
Results: Overall, 14 children (6 with SPE, 8 with ns-PE) were identified. Septic pulmonary embolism episodes were secondary to endocarditis, musculoskeletal and soft tissue infections. All children with SPE were in similar age (9.5-15 years), while the age range of ns-PE was 2 months-17.9 years. The clinical presentation was similar in both groups, excluding higher rates of fever in SPE (100% vs. 12.5%, p=0.005). Fibrinogen levels were significantly higher in the SPE group (805 mg/dL vs. 467 mg/dL, p=0.005). The presence of a risk factor (identified in thrombophilia workup or imaging) was noted in 0% and 87.5% of the SPE and ns-PE patients, respectively (p=0.005). Antithrombotic treatment for >4 months was administrated to 0% and 87.5% of SPE and ns-PE patients, respectively (p=0.005). One ns-PE patient had a second event of thromboembolism compared to none in the SPE group.
Conclusions: Septic pulmonary embolism in children is a sub-group of pulmonary embolism that is not associated with hematologic risk factor or prolonged anti-thrombotic therapy and has a favorable outcome.