Presentation
Persistent oxygen requirement despite high-flow. Initially treated as transient tachypnea of the newborn but failing to improve. Echocardiogram was suggestive of pulmonary embolism.
Patient Data
Non-occlusive saddle embolus straddling the pulmonary arterial bifurcation. Extensive clot burden through the right pulmonary artery, the truncus anterior, the interlobar artery, and the proximal portions of nearly all segmental arteries.
Arterial opacification is seen distally in most segmental / subsegmental vessels. No definite right atrial or ventricular thrombus.
The embolus appears acute, causing expansion of many of the involved right-sided pulmonary vessels and the left lower lobe vessels, though the circumferential peripheral enhancement suggests a degree of thrombus shrinkage.
Hypoattenuation of the right lung likely reflects oligemia.
Case Discussion
Pulmonary emboli are relatively uncommon in children.
Risk factors include congenital heart disease, central venous lines, and thrombophilias.
The patient underwent surgical embolectomy. Thrombotic screen was negative and no cause was identified in this case.
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