PULMONARY THROMBOEMBOLISM IN A CHILD AFTER BURN INJURY

Year 2020, Volume: 22 Issue: 3, 478 - 482, 31.12.2020

Tahir Dalkıran , Olcay Güngör , Yaşar Kandur , Besra Dağoğlu , Can Acıpayam , Ayşegül Alpcan , Serkan Tursun

https://doi.org/10.24938/kutfd.792374

Abstract

Pulmonary embolism is rarely diagnosed in pediatric burn patients and is often only discovered at autopsy. Herein we would like to present the case of a pediatric patient with pulmonary thromboembolism who was burnt by hot water at home. A 4-year-old girl who was treated at an external center for 9 days due to second degree burn injuries in both legs. After the discharge she had suddenly become restless and than gone unconscious. Since pulmonary thromboembolism was suspected as the cause of cardiopulmonary arrest, a pulmonary computed tomography angiogram was taken, which showed a thrombus in the lobar and segmental branches of the right pulmonary artery supplying the right lower lobe. Enoxaparin sodium treatment (2×1mg/kg) was initiated. At day 16, a control computed tomography angiogram showed that the thrombus in the lobar and segmental branches of the pulmonary artery had disappeared. This case report illustrates the importance of chemoprophylaxis against pulmonary embolism in both pediatric and adult burn patients. In such cases, especially the severe ones, a sudden deterioration of patient’s clinical status in the form of respiratory distress or failure should raise suspicion about the possibility of pulmonary embolism.

Keywords

burn, pulmoner thromboembolism, pediatric, heparin

Yanık Sonrası Pulmoner Tromboemboli Gelişen Bir Çocuk Olgu

Abstract

Pulmoner tromboemboli, pediatrik yaş grubunda nadiren tanısı konulan bir hastalıktır ve tanı genellikle otopsi ile konulur. Bu çalışmada evde, sıcak su teması sebebiyle oluşan yanıktan sonra pulmoner tromboemboli gelişen bir çocuk olgusu sunulmuştur. İki bacakta ikinci derece yanık yaralanması nedeniyle 9 gün boyunca dış merkezde tedavi görmekte iken taburculuk günü, aniden solunum sıkıntısı ve bilinç kaybı ile kardiyopulmoner arrest gelişen 4 yaşındaki kız çocuğu yoğun bakım ünitemize kabul edildi. Kardiyopulmoner arrest nedeni olarak pulmoner emboli düşünülmesi üzerine hastaya akciğer bilgisayarlı tomografi ile anjiografi yapıldı. Sağ pulmoner arterin lober ve segmental dallarında trombüs saptandı. İntravenöz anfraksiyone düşük molekül ağırlıklı heparin (Enoksaparin sodyum 2×1mg / kg) tedavisine başlandı. On altıncı günde yapılan kontrol bilgisayarlı tomografi anjiyografisinde, pulmoner arterin lober ve segmental dallarındaki trombüsün kaybolduğu saptandı. Yanık hastalarında solunum sıkıntısı ile kardiyopulmoner arrest gelişmesi halinde ayırıcı tanıda pulmoner emboli mutlaka düşünülmelidir. Bu olgu sunumu hem çocuk hem de yetişkin yanık hastalarında pulmoner emboli olasılığına karşı kemoprofilaksinin önemini göstermektedir

Keywords

yanık, pulmoner tromboemboli, çocuk, heparin

References

• 1. Babyn PS, Gahunia HK, Massicotte P. Pulmonary thromboembolism in children. Pediatr Radiol 2005;35(3):258-74.
• 2. Rue LW, Cioffi WG, Rush R, McManus WF, Pruitt BA Jr. Thromboembolic complications in thermally injured patients. World J Surg 1992;16(6):1151-4.
• 3. Wahl WL, Brandt MM. Potential risk factors for deep venous thrombosis in burn patients. J Burn Care Rehabil 2001;22(2):128–31.
• 4. Reith FC, Van den Brande R, Synnot A, Gruen R, Maas AI. The reliability of the Glasgow Coma Scale: a systematic review. Intensive Care Med 2006;42(1):3-15.
• 5. Barret JP, Dziewulski PG. Complications of the hypercoagulable status in burn injury. Burns 2006;32(8):1005-8.
• 6. Mullins F, Mian MA, Jenkins D, Brandigi C, Shaver JR, Friedman B et al. Thromboembolic complications in burn patients and associated risk factors. J Burn Care Res. 2013;34(3):355-60.
• 7. Heymans O, Lemaire V, Nélissen X, Verhelle N, Jacquemin D, Jacob E. Deep vein thrombosis in a burn patient. Rev Med Liege. 2002;57(9):587-90.
• 8. Gülcü A, Akkoçlu A, Yılmaz E, Öztürk B, Osma E, Şengün B. The comparison of the clinical probability with computed tomography pulmonary angiography findings for the pulmonary embolism (PE) diagnosis. Tuberk Toraks. 2007;55(2):174–81.
• 9. Heit JA, O'Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism a population-based study. Arch Intern Med. 2002;162(11):1245-8.
• 10. Torbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P et al. Guidelines on the diagnosis and management of acute pulmonary embolism the task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008;29(18):2276–315.
• 11. Ghanima W, Abdelnoor M, Holmen LO, Nielssen BE, Sandset PM. The association between the proximal extension of the clot and the severity of pulmonary embolism (PE): a proposal for a new radiological score for PE. J Intern Med. 2007;261(1):74-81.
• 12. Ginsberg JS, Wells PS, Kearon C, Anderson D, Crowther M, Weitz JI et al. Sensitivity and specificity of a rapid whole blood assay for D-dimer in the diagnosis of pulmonary embolism. Ann Intern Med. 1998;129(12):1006–11.
• 13. Arseven O, Sevinç C, Alataş F, Ekim N, Erkan L, Findik S, et al. The report for the diagnosis and therapeutical consensus of pulmonary thromboembolism. Tur Toraks Der. 2009;10(11):7-47.
• 14. Tapson VF, Witty LA. Massive pulmonary embolism. Diagnostic and therapeutic strategies. Clin Chest Med. 1995;16(2):329-40.
• 15. Desai MH, Linares HA, Herndon DN. Pulmonary embolism in burned children. Burns. 1989;15(6):376-380.
• 16. Fecher AM, O'Mara MS, Goldfarb IW, Slater H, Garvin R, Birdas TJ et al. Analysis of deep vein thrombosis in burn patients. Burns. 200430(6):591-93.
• 17. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR et al. American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th Edition). Chest. 2008;133(6):381S–453S.