Pulmonary Embolism in Children.

Pulmonary embolism is generally believed to be rare in childhood, and my own survey of the published material suggests that under 50 cases have so far been recorded. Stevenson and Stevenson (1949), who surveyed published reports from all over the world and reported a case in 1949, could find only 30 reports of which only 16 had had complete autopsies. Not all cases, however, are fatal. Cashman (1956) reported an embolus in a boy of 9 years who recovered completely. The first reported case appears to have been almost exactly a century ago when Ldschner (1861) described a pulmonary embolus in a 9-year-old boy, which followed phlebitis associated with a fracture of the tibia. His case typifies many of the earlier case reports of the pre-antibiotic days where emboli appeared to follow injury to bones and muscles (Rosenbloom and Henderson, 1935). Rupp (1921) tabulated 11 cases of fatal pulmonary embolism that had followed prolonged wasting disease in children under the age of 10 years. Several cases have been reported following prolonged or acute sepsis (Wessen, 1922; Fleischmann, 1929; Stulik and Rust, 1929; Jones, 1930; Hosoi, 1932). My own interest in pulmonary emboli in children was stimulated by the symptoms and lethal complication of the ventricular-atrial Spitz Holter valve in children with hydrocephalus (Emery and Hilton, 1961). Many of these children succumb from pulmonary embolism from clots that arise around the tube in the right atrium. All cases of emboli associated with the Spitz Holter valve or with primary disease of the heart have, however, been excluded in the present survey. This report concerns 25 cases of fatal pulmonary embolism that we have seen in our own material during the past 10 years, and an attempt is made to assess its importance in the pathology of the lung in children.