What’s Your Diagnosis?  Pediatric Venous Thromboembolism

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Brief Resolved Unexplained Events: Practical Evaluation and Management in the Emergency Department right.

Case Presentation: Identification and Management of Pediatric Venous Thromboembolism in the Emergency Department

A 13-year-old girl is brought into the ED after she developed dyspnea and pleuritic chest pain while watching a basketball game... 

• The girl is tachypneic and mildly tachycardic, with an oxygen saturation of 98% on room air. As you begin the workup, her mother mentions that her daughter underwent pinning of a leg fracture recently and has been immobile for the past 6 days. She says the girl started taking oral contraceptives 3 months ago. 
• How should you begin your workup? Does this patient require emergent imaging to rule out a pulmonary embolism? 

Case Conclusion

You identified 2 risk factors for a VTE: recent immobilization and oral contraceptive use. However, you also appreciated that there may be other more common conditions causing her symptoms. You obtained an ECG, which showed sinus tachycardia but was otherwise normal, and a chest x-ray, which demonstrated a small left-sided spontaneous pneumothorax. Given the size of the pneumothorax, conservative management was indicated. She was placed on supplemental oxygen and admitted to the inpatient unit for monitoring. 

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Last Updated on July 15, 2024