Septic pulmonary embolism children

The triad of acute osteomyelitis, deep venous thrombophlebitis, and septic pulmonary embolism is a rare, but life-threatening syndrome in children that requires prompt recognition and treatment. We report two cases of acute osteomyelitis complicated by septic thrombophlebitis and pulmonary emboli. Both patients required operative drainage to remove the septic focus. Recognition of any one component of the triad should prompt a search for the other associated disorders. Aggressive management with early antibiotic administration, anticoagulation, and surgical debridement can be life saving...

OBJECTIVE: This study was designed to evaluate the clinical characteristics, acquired and congenital risk factors, treatment strategies, and long-term outcome in pediatric pulmonary thromboembolism (PTE) cases followed in our center in Turkey. SUBJECTS: Of the total 470 pediatric patients with thrombosis referred to our center, 16 (3.4%) had PTE. The mean age of the children with PTE was 10.3 +/- 6.8 years (range: 1.5-20.0, median: 10.5), and 12 (75.0%) were boys...

Septic pulmonary embolism (PE) is a diagnosis seldom considered in children. A 15 year old girl presented with fever, extremity swelling and pain for 5 days. Chest radiograph revealed a large, round density in the right lung and consolidation areas in peripheral portions of both lungs. Computed tomography showed bilateral multiple round and cavitary nodules in peripheral portions of both lungs, pleural effusion in the right lung and hypodense round lesion (8 cm by 4 cm) in the superior segment of right lower lobe, characteristic of PE...

We report four adult patients who presented with septic pulmonary emboli and community-acquired methicillin-resistant Staphylococcus aureus bacteremia associated with deep tissue infections, such as pyomyositis, osteomyelitis, and prostatic abscess. The patients lacked evidence of right-sided endocarditis or thrombophlebitis. This association, previously described in children, may also be important in adults.

Pyomyositis is a suppurative infection of skeletal muscle most commonly caused by Staphylococcus aureus. It is mainly encountered in children and immunocompromised. Eight year old previously healthy girl presented with confusion, fever and swelling of the right knee two days after a trauma. Abdominal ultrasonography and computerized tomography taken upon development of hematemesis revealed no pathology in the abdomen, but potential bleeding sites in lung sections. Thorax CT images were interpreted in favor of septic pulmonary emboli due to the presence of peripheral nodular consolidation areas with central cavitation, mostly pathchy in medial areas...

A 13-year-old white boy was admitted to an outside institution for antibiotic treatment of right preseptal cellulitis. He subsequently developed a right orbital abscess, which could not be located on surgical exploration. On postoperative day 2, he developed acute chest pain and was transferred to Children's Hospital of Michigan for evaluation and treatment. CT of the thorax demonstrated multiple, bilateral lower lobe lesions consistent with septic pulmonary embolism. The right orbit was re-explored with successful drainage of an intraconal orbital abscess...

BACKGROUND: Venous thrombosis (VT) in children with Staphylococcus aureus osteomyelitis occurs rarely. We describe clinical features of infections and molecular characterization of isolates of children at Texas Children's Hospital with S aureus osteomyelitis and VT. METHODS: We reviewed records and imaging studies (chest radiographs, ultrasound, computed tomography, and MRI) of 9 patients at Texas Children's Hospital with acute S aureus osteomyelitis and new onset VT between August 1999 and December 2004...

OBJECTIVE: Lemierre's syndrome, or jugular vein thrombosis (JVT) associated with anaerobic infection of the head and neck and frequently complicated by septic pulmonary embolism (PE), has historically been described as a disease of young adults. In recent years, an increasing number of case reports of childhood Lemierre's syndrome have been published, focusing mostly on the clinical and laboratory findings at disease presentation and the outcomes of infection. Given the potentially life-threatening thromboembolic complications of this disorder, we reviewed our single-institutional experience with pediatric Lemierre's and Lemierre's-like syndromes (LALLS) from within the context of a larger cohort study of thrombosis in children...

Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis...

OBJECTIVE: To assess the apparent increase in the diagnosis of Lemierre syndrome (LS) and other Fusobacterium necrophorum infections at a large children's hospital. Infections with F necrophorum ranged from peritonsillar abscess to potentially fatal LS. LS is an oropharyngeal infection characterized by septic thrombophlebitis of head and neck veins, complicated by dissemination of septic emboli to pulmonary and systemic sites. METHODS: Review of the medical and laboratory records was conducted of all patients who were seen at or admitted to the Children's Hospital of Wisconsin with the diagnosis of LS and/or isolation of F necrophorum from a clinical specimen between January 1995 and January 2002...

AIMS: To review the clinical presentation, radiographic findings, and outcome of therapy in children with septic pulmonary embolism. METHODS: Retrospective analysis of patients in a tertiary paediatric facility in northern Taiwan. RESULTS: Ten children were identified with septic pulmonary emboli in a four year retrospective chart review between 1998 and 2001. Seven were immunocompetent, two were premature infants, one had beta thalassemia major...

Deep vein thrombosis (DVT) is uncommon in children but can occur given certain circumstances. The authors describe four children in whom DVT developed in association with musculoskeletal sepsis. One child died. Prothrombotic screens were performed on the three surviving children, showing normal hematologic parameters. The severity of DVT complicating musculoskeletal sepsis is emphasized, particularly the potential for septic embolic complications. Deep vein thrombosis should be considered in any child with musculoskeletal sepsis, particularly when a limb is severely swollen or when there are pulmonary septic emboli...

The paper provides evidence for the pathogenetic approach to treating acute lung lesion (ALL) and adult respiratory distress syndrome (ARDS). An algorithm of the use of Russian lung surfactant preparations: CT-HL and CT-BL has been developed. In involves earlier (the first days following the onset of respiratory failure) use of surfactant, its combined bolus intratracheal or intrabronchial administration in doses of 200-400 mg/m2, followed by continuous (5-day) aerosol inhalation in doses of 20-30 mg/h for children and 30-75 mg/h for adults until pronounced clinical and X-ray effects are shown...

We present a necropsy study of 25 children (age 0-15 years) and 7 adolescents (age 16-18 years) with the diagnosis of macroscopic pulmonary thromboembolism (PTE). PTE occurred along with a serious disease, e.g. tumour or general infection, and when the subjects had some of the following risk factors, e.g. immobilization, tumours, cardiovascular diseases, operations, obesity, septic state, peritonitis, cachexia and placement of central venous catheters.

The frequency of pulmonary embolism was investigated in a 10-year period from 1971 to 1982. During this time approximately 30 000 operations in 60 000 surgical and medical patients were performed. In seven patients, six boys and one girl, pulmonary embolism was diagnosed. This includes six patients with septic embolism, arising in three cases from subacute endocarditis, in two from osteomyelitis of the humerus and in one from coxitis. Only in one patient, a boy who was operated for perforated appendicitis, pulmonary embolism resulted as a complication of left-sided ileofemoral thrombosis...

Two children with ventricular septal defect and tricuspid valve endocarditis are presented. One of them had ongoing endocarditis with septic pulmonary embolism, the other suffered from florid endocarditis presumably 3 months before the study. M-mode echocardiography showed echodense masses in the right ventricular outflow tract in one and anomalous systolic anterior movement of tricuspid valve tissue in the other patient. Sectorechocardiography demonstrated in both children abnormal masses originating from the tricuspid valve and extending into the right ventricular outflow tract...

During the last three decades it has become clear that removal of the spleen, for any reason, is not a benign procedure. In both adults and children splenectomy places the patient at significantly higher risk of overwhelming infection, compared to the normal population. The risk of the post-splenectomy septic syndrome is lifelong and is not eliminated by the administration of polyvalent pneumococcal vaccine. Thus far, the reported rate of overwhelming sepsis in asplenic individuals has ranged from 2.5-13.5%...

Deep venous thromboses in the lower extremities were observed in three boys aged 8, 10, and 12 years. In one case, it must have originated from circulatory depression during diabetic ketoacidosis. In two children, osteomyelitis was detected in the proximity; they developed septic pulmonary embolism. Osteomyelitis and septic arthritis as possible cause or consequence should be actively looked for in septic thromboembolism.

Sodium nitroprusside was used in 18 children aged 1 to 13 years with clinical and hemodynamic signs of low cardiac output syndrome secondary to septic pancarditis, lung edema, thromboembolism of pulmonary artery branches. Central and peripheral hemodynamics has been studied by impedance plethysmography prior to and during the first day of sodium nitroprusside infusion. A considerable improvement of hemodynamic parameters and the patients' conditions has been established. Effective dosages and indications for the drug use in children have been elaborated...