Obese Adolescent with Factor V Leiden-Related Pulmonary Embolism: Case-Based Insight into Paediatric Thrombosis Management.

Background/

Objectives

Paediatric pulmonary embolism (PE) is rare but potentially lethal, and its diagnosis is complicated by non-specific presentations and multiple predisposing risk factors. We describe a 15-year-old girl who presented with features of pulmonary hypertension and was found to have extensive pulmonary embolism with right heart strain.

Methods

The diagnosis was established with echocardiography, computed tomography pulmonary angiography (CTPA), and Doppler ultrasonography.

Results

Her predisposing risk factors comprised obesity (BMI 33 kg/m2), a family history of thrombosis, and heterozygous Factor V Leiden. In retrospect, a six-week illness treated as bronchitis, with haemoptysis and exertional syncope, was the probable index embolic event; the markedly elevated right-sided pressures tolerated without haemodynamic collapse indicate a right ventricle that had adapted over that interval. Anticoagulation with low-molecular-weight heparin, titrated to anti-factor Xa activity, was followed by a vitamin K antagonist while antiphospholipid syndrome was excluded and then by rivaroxaban, with clinical, biochemical, and radiographic improvement.

Conclusions

This report underscores the need for greater awareness of PE in children, the value of revisiting a recent respiratory illness as a possible index embolic event, and the evolving role of direct oral anticoagulants in its management.