Key result
Sequential anticoagulation with LMWH, acenocoumarol, and rivaroxaban resolves extensive pulmonary embolism in an adolescent.
Why the study?
Paediatric pulmonary embolism is rare but potentially lethal, and diagnosis is complicated by non-specific presentations and multiple predisposing risk factors.
Case Report (n=1)
No
This case highlights the importance of considering subacute pulmonary embolism in adolescents presenting with features of pulmonary hypertension, especially with underlying risk factors like obesity and inherited thrombophilia.
May inform DOAC sequencing in adolescent PE; hypothesis-generating and leaves open need for pediatric RCTs.
Background/Objectives: Paediatric pulmonary embolism (PE) is rare but potentially lethal, and its diagnosis is complicated by non-specific presentations and multiple predisposing risk factors. We describe a 15-year-old girl who presented with features of pulmonary hypertension and was found to have extensive pulmonary embolism with right heart strain. Methods: The diagnosis was established with echocardiography, computed tomography pulmonary angiography (CTPA), and Doppler ultrasonography. Results: Her predisposing risk factors comprised obesity (BMI 33 kg/m2), a family history of thrombosis, and heterozygous Factor V Leiden. In retrospect, a six-week illness treated as bronchitis, with haemoptysis and exertional syncope, was the probable index embolic event; the markedly elevated right-sided pressures tolerated without haemodynamic collapse indicate a right ventricle that had adapted over that interval. Anticoagulation with low-molecular-weight heparin, titrated to anti-factor Xa activity, was followed by a vitamin K antagonist while antiphospholipid syndrome was excluded and then by rivaroxaban, with clinical, biochemical, and radiographic improvement. Conclusions: This report underscores the need for greater awareness of PE in children, the value of
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Bossowski et al. (2026) conducted a case report in Pulmonary embolism (n=1). Anticoagulation (LMWH, acenocoumarol, rivaroxaban) was evaluated on Clinical, biochemical, and radiographic improvement. Anticoagulation therapy with LMWH, acenocoumarol, and rivaroxaban led to marked clinical, biochemical, and radiographic improvement in a 15-year-old girl with extensive pulmonary embolism.
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