Recommended Citation
Bentsen C, Bikeyeva V, Paolella G, et al. From Dyspnea to Recovery: Multidisciplinary Management of Hormonal Contraceptive-Associated PE in an Adolescent. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
The incidence of pulmonary embolism (PE) in hospitalized children is rare, with only 56 per 100,000 patients affected, predominantly females. Although rare, the use of hormonal contraceptives (HC) in adolescent females is linked to 79% of all venous thromboembolism (VTE) and PE cases. This risk is further doubled when using transdermal HC compared to oral. This case highlights the importance of recognizing the life-threatening hypercoagulable side effects of HC in adolescent women, particularly when symptoms may mistakenly be attributed to benign causes.
Description:
A 17-year-old female with no medical history presented with a two-week history of pleuritic chest pain and severe dyspnea with minimal exertion after initial outpatient treatment for presumed muscle strain. She had started transdermal HC two months before presentation. On admission, she was tachycardic to 130 bpm but otherwise hemodynamically stable, saturating well on ambient air. Laboratory evaluation revealed normal troponin and NT-proBNP levels, with a markedly elevated D-dimer of 11.62 mg/dL (normal 0.0–0.5 mg/dL). Bilateral lower extremity venous duplex ultrasonography showed no evidence of VTE. Computed tomography pulmonary angiography demonstrated extensive bilateral pulmonary emboli, with significant clot burden near the left pulmonary artery bifurcation and evidence of pulmonary infarction at the lung bases. Transthoracic echocardiography showed no evidence of right heart strain. The patient was admitted to the pediatric intensive care unit and started a heparin infusion. Despite relative hemodynamic stability, a multidisciplinary team of hematology, critical care, and interventional cardiology elected to proceed with a hypercoagulable workup and mechanical thrombectomy. Bilateral pulmonary artery thrombi were successfully removed using the Inari FlowTriever device, resulting in rapid symptomatic improvement.
Discussion:
This case illustrates the importance of maintaining a high clinical index of suspicion for uncommon, yet serious thromboembolic complications associated with HC use in adolescents. Although the patient lacked right heart strain and biomarker elevation, the degree of clot burden, pulmonary infarction, and severe exertional symptoms supported advanced intervention. This case highlights the value of timely multidisciplinary decision-making, enabling an often-missed extensive hematologic workup, and supports the need to establish a PE response team to improve efficiency and outcomes.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
From Dyspnea to Recovery: Multidisciplinary Management of Hormonal Contraceptive-Associated PE in an Adolescent
Introduction/Background:
The incidence of pulmonary embolism (PE) in hospitalized children is rare, with only 56 per 100,000 patients affected, predominantly females. Although rare, the use of hormonal contraceptives (HC) in adolescent females is linked to 79% of all venous thromboembolism (VTE) and PE cases. This risk is further doubled when using transdermal HC compared to oral. This case highlights the importance of recognizing the life-threatening hypercoagulable side effects of HC in adolescent women, particularly when symptoms may mistakenly be attributed to benign causes.
Description:
A 17-year-old female with no medical history presented with a two-week history of pleuritic chest pain and severe dyspnea with minimal exertion after initial outpatient treatment for presumed muscle strain. She had started transdermal HC two months before presentation. On admission, she was tachycardic to 130 bpm but otherwise hemodynamically stable, saturating well on ambient air. Laboratory evaluation revealed normal troponin and NT-proBNP levels, with a markedly elevated D-dimer of 11.62 mg/dL (normal 0.0–0.5 mg/dL). Bilateral lower extremity venous duplex ultrasonography showed no evidence of VTE. Computed tomography pulmonary angiography demonstrated extensive bilateral pulmonary emboli, with significant clot burden near the left pulmonary artery bifurcation and evidence of pulmonary infarction at the lung bases. Transthoracic echocardiography showed no evidence of right heart strain. The patient was admitted to the pediatric intensive care unit and started a heparin infusion. Despite relative hemodynamic stability, a multidisciplinary team of hematology, critical care, and interventional cardiology elected to proceed with a hypercoagulable workup and mechanical thrombectomy. Bilateral pulmonary artery thrombi were successfully removed using the Inari FlowTriever device, resulting in rapid symptomatic improvement.
Discussion:
This case illustrates the importance of maintaining a high clinical index of suspicion for uncommon, yet serious thromboembolic complications associated with HC use in adolescents. Although the patient lacked right heart strain and biomarker elevation, the degree of clot burden, pulmonary infarction, and severe exertional symptoms supported advanced intervention. This case highlights the value of timely multidisciplinary decision-making, enabling an often-missed extensive hematologic workup, and supports the need to establish a PE response team to improve efficiency and outcomes.
Affiliations
Advocate Lutheran General Hospital