PURPOSE: Pulmonary emboli (PE) are one of the major complications associated with total parenteral nutrition (TPN). Ventilation-perfusion scintigraphy (V/Q) remains the most used test for the diagnosis of PE and follow-up of patients on TPN. The aim of our study was to demonstrate the high prevalence of undiagnosed PE in children on TPN. METHODS: The medical and imaging files of 64 patients on TPN who underwent V/Q examinations covering the period of 1986-2004 were reviewed. Children were aged between 3.18 months and 21.6 years. TPN was started at birth (range 0-15 years). All children had a normal chest radiograph and no symptoms at the time of the V/Q scan. A comparative analysis between the prevalence of PE and risk factors (number of days per week with lipophilic content of the TPN, bowel inflammation and thrombophilic factors (protein C and S) was performed. RESULTS: Of the 64 patients, 25 (39%) had an abnormal V/Q scan. A total of 29 PE episodes were diagnosed in all patients. Two children had three episodes of PE. The median age at PE diagnosis was 4.6 years. In 17 patients (68%) diagnosis was achieved on the first V/Q scan performed. PE was bilateral in 56% and unilateral in 44%. PE was the main cause of 2 out 15 recorded deaths. All risk factors were associated with an increase in PE prevalence by statistical analysis. CONCLUSION: PE is underdiagnosed in children on long-term TPN. Lung V/Q scintigraphy is useful in the diagnosis of PE in children with a low pretest probability.
PURPOSE: Pulmonary emboli (PE) are one of the major complications associated with total parenteral nutrition (TPN). Ventilation-perfusion scintigraphy (V/Q) remains the most used test for the diagnosis of PE and follow-up of patients on TPN. The aim of our study was to demonstrate the high prevalence of undiagnosed PE in children on TPN. METHODS: The medical and imaging files of 64 patients on TPN who underwent V/Q examinations covering the period of 1986-2004 were reviewed. Children were aged between 3.18 months and 21.6 years. TPN was started at birth (range 0-15 years). All children had a normal chest radiograph and no symptoms at the time of the V/Q scan. A comparative analysis between the prevalence of PE and risk factors (number of days per week with lipophilic content of the TPN, bowel inflammation and thrombophilic factors (protein C and S) was performed. RESULTS: Of the 64 patients, 25 (39%) had an abnormal V/Q scan. A total of 29 PE episodes were diagnosed in all patients. Two children had three episodes of PE. The median age at PE diagnosis was 4.6 years. In 17 patients (68%) diagnosis was achieved on the first V/Q scan performed. PE was bilateral in 56% and unilateral in 44%. PE was the main cause of 2 out 15 recorded deaths. All risk factors were associated with an increase in PE prevalence by statistical analysis. CONCLUSION: PE is underdiagnosed in children on long-term TPN. Lung V/Q scintigraphy is useful in the diagnosis of PE in children with a low pretest probability.
Authors: U Nowak-Göttl; K Auberger; S Halimeh; R Junker; J Klinge; W D Kreuz; M Ries; N Schlegel Journal: Thromb Haemost Date: 1999-09 Impact factor: 5.249
Authors: C H van Ommen; H Heyboer; J W Groothoff; R Teeuw; D C Aronson; M Peters Journal: J Pediatr Hematol Oncol Date: 1998 Nov-Dec Impact factor: 1.289
Authors: Martin Boehne; Thomas Jack; Harald Köditz; Kathrin Seidemann; Florian Schmidt; Michaela Abura; Harald Bertram; Michael Sasse Journal: BMC Pediatr Date: 2013-02-06 Impact factor: 2.125