Comparison of septic and nonseptic pulmonary embolism in children

Background: Septic pulmonary embolism (SPE) in children is a rare disease. Data are scarce regarding the clinical and laboratory manifestation of SPE compared with nonseptic pulmonary embolism (ns-PE). Furthermore, specific guidelines for the management of SPE in children are lacking. Aim: We compared the clinical course and outcome of children with SPE and ns-PE. Methods: A retrospective, cohort study of hospitalized children, 2005–2020, with documented pulmonary embolism imaging. Results: Sixteen children (eight SPE, eight ns-PE) were identified. Episodes of SPE occurred secondary to endocarditis, musculoskeletal and soft tissue infections, with Staphylococcus aureus (n = 4) and streptococcus spp. (n = 2) as the most common pathogens. Radiographically, SPE presented as a microvascular disease with parenchymatic nodules/cavitations, whereas ns-PE presented as larger vessel disease with filling defects. Risk factors (including thrombophilia) were noted in 0% and 87.5% of SPE and ns-PE patients, respectively (p <.01). Pulmonary embolism diagnosis was delayed in SPE compared with ns-PE (median: 8.5 days vs. 1 day). The SPE group had higher rates of fever (100% vs. 12.5%, p <.01), C-reactive protein (CRP levels; 18.49 vs. 4.37 mg/dl, p =.02), and fibrinogen levels (880 vs. 467 mg/dl, p <.001). Antithrombotic treatment for >4 months was administrated to 14.3% and 87.5% of SPE and ns-PE patients, respectively (p <.01). One ns-PE patient had a second thromboembolic event compared to none in the SPE group. Conclusions: SPE in children is a unique subgroup of PE with different clinical and laboratory findings that requires a different diagnostic approach and probably shorter duration of antithrombotic treatment.