MASSIVE PULMONARY-EMBOLISM DUE TO A CATHE TER TIP THROMBUS IN A CHILD

A case is reported of a 9-year-old girl admitted with a subarachnoid h aemorrhage. Her neurological recovery was favourable after the emboliz ation of a cerebral arterio-venous malformation. She stayed in ICU wit h mechanical ventilation because of a bacterial pneumonia and a postex tubation laryngeal oedema. She required insertion of a polyurethane su bclavian catheter, as a peripheral venous access was not available. Fi ve days later, the child suffered a sudden respiratory distress withou t changes of the electrocardiogram and the chest X-ray. The diagnosis of pulmonary embolism was suspected because of the presence of the cen tral venous catheter, a catheter dysfunction and a superior vena cava syndrome. A catheter tip thrombus was shown by angiography as well as a thrombus in the pulmonary artery, a 90 % obstruction of the proximal valvular tree of the right lung, a 10 to 15 % distal obstruction in t he left lung, a complete obstruction of the superior vena cava (SCV). The thrombolytic therapy was contra-indicated in this case because of the neurological pathology. Heparin was given by continuous intravenou s infusion. When heparin concentration was at an appropriate level, th e catheter was removed. Its microbiological culture remained negative. The next day, another angiography showed a partial permeability of th e SVC and a better right pulmonary perfusion. During this procedure, t he haemodynamic assessment showed only moderate abnormalities. Therefo re the surgical treatment was not indicated and the heparin continued. The child recovered gradually with a normalization of the lung scinti graphy.