Recommended Citation
Michalopoulos GC, Bikeyeva V, Adams J, et al. Bilateral Pulmonary Emboli Requiring Emergent Thrombectomy in a Pediatric Patient. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Pediatric Pulmonary Emboli (PE) are rare but have a high mortality rate. Evidence based guidelines for PE management in children are limited, and most recommendations stem from adult populations. Decisions regarding pursuing systemic thrombolysis, surgical embolectomy, catheter-based interventions, or medical management are often made on a case-by-case basis by a multidisciplinary team after careful consideration of the risks and benefits. We present a case of a 17-year-old female who was successfully treated with mechanical thrombectomy for bilateral PE after recent initiation of oral contraceptives.
Description:
Patient presented to the ED with dyspnea. Vital signs showed tachycardia, hypoxia, and hypotension. Labs revealed significantly elevated NT-pro-BNP, Troponin, and 4.36 mg/L D-Dimer. TTE showed a severely dilated Right Ventricle (RV) with reduced systolic function, interventricular septal bowing, and tricuspid regurgitation. CTA PE revealed prominent bilateral pulmonary emboli involving all lobes of the lungs. Patient was admitted to Pediatric Intensive Care Unit on HFNC, milrinone, and heparin infusions. A multidisciplinary discussion amongst Pediatric Cardiology, Hematology, and Adult Interventional Cardiology determined she would benefit from thrombectomy given her severe symptoms. Patient’s family elected to proceed, and emergent bilateral thrombectomy was successfully performed. Post-thrombectomy the mean Pulmonary Artery Pressure improved from 36 to 20 mmHg, with complete resolution of tachycardia, hypotension, and hypoxia. Repeat TTE showed normal RV size and function, and resolution of tricuspid regurgitation.
Discussion:
Mechanical thrombectomy was performed on our patient because of the extent of the PE, the severity of right heart strain, and concerns for right heart failure from persistent pulmonary hypertension. Guidelines for PE management in children are limited to case reports and small retrospective randomized trials, thus current recommendations are based on data from adult populations. Mechanical thrombectomy has been growing in popularity as an intervention for sub-massive PE because of its benefits regarding length of hospital stay and reduction in ICU admissions. This case highlights the effective use of mechanical thrombectomy as an emergent intervention for PE in a pediatric patient. Mortality from PE is high in pediatric populations underscoring the importance of early recognition and effective intervention.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
Bilateral Pulmonary Emboli Requiring Emergent Thrombectomy in a Pediatric Patient
Introduction/Background:
Pediatric Pulmonary Emboli (PE) are rare but have a high mortality rate. Evidence based guidelines for PE management in children are limited, and most recommendations stem from adult populations. Decisions regarding pursuing systemic thrombolysis, surgical embolectomy, catheter-based interventions, or medical management are often made on a case-by-case basis by a multidisciplinary team after careful consideration of the risks and benefits. We present a case of a 17-year-old female who was successfully treated with mechanical thrombectomy for bilateral PE after recent initiation of oral contraceptives.
Description:
Patient presented to the ED with dyspnea. Vital signs showed tachycardia, hypoxia, and hypotension. Labs revealed significantly elevated NT-pro-BNP, Troponin, and 4.36 mg/L D-Dimer. TTE showed a severely dilated Right Ventricle (RV) with reduced systolic function, interventricular septal bowing, and tricuspid regurgitation. CTA PE revealed prominent bilateral pulmonary emboli involving all lobes of the lungs. Patient was admitted to Pediatric Intensive Care Unit on HFNC, milrinone, and heparin infusions. A multidisciplinary discussion amongst Pediatric Cardiology, Hematology, and Adult Interventional Cardiology determined she would benefit from thrombectomy given her severe symptoms. Patient’s family elected to proceed, and emergent bilateral thrombectomy was successfully performed. Post-thrombectomy the mean Pulmonary Artery Pressure improved from 36 to 20 mmHg, with complete resolution of tachycardia, hypotension, and hypoxia. Repeat TTE showed normal RV size and function, and resolution of tricuspid regurgitation.
Discussion:
Mechanical thrombectomy was performed on our patient because of the extent of the PE, the severity of right heart strain, and concerns for right heart failure from persistent pulmonary hypertension. Guidelines for PE management in children are limited to case reports and small retrospective randomized trials, thus current recommendations are based on data from adult populations. Mechanical thrombectomy has been growing in popularity as an intervention for sub-massive PE because of its benefits regarding length of hospital stay and reduction in ICU admissions. This case highlights the effective use of mechanical thrombectomy as an emergent intervention for PE in a pediatric patient. Mortality from PE is high in pediatric populations underscoring the importance of early recognition and effective intervention.
Affiliations
Advocate Lutheran General Hospital