A case of pulmonary thromboembolism associated with hypereosinophilia in a child

Abstract

Pulmonary thromboembolism is a very rare event in children, but the mortality rate is reported to be approximately 10%. The majority of children with thromboemboli have multiple risk factors, such as a catheter-related thrombosis, an infection, and a congenital prothrombotic disorder. Hypereosinophilia is very rarely associated with pulmonary emboli in adults; however, this condition has not been reported in children. We present a 12-year-old boy who had a pulmonary thromboembolism and deep vein thrombosis associated with hypereosinophilia and thrombocytopenia. The thromboembolism was managed with anticoagulant therapy and the hypereosinophilia resolved spontaneously.

Keywords: Child; Eosinophilia; Pulmonary thromboembolism.

Fig. 1

Chest radiograph on admission. Chest radiography showed right lower lung haziness mimicking lobar pneumonia.

Fig. 2

Computed tomography with angiography on admission. A and B: contrast-enhanced CT angiography showed filling defects (arrows) in right upper lobar pulmonary artery (A) and both lower lobar pulmonary arteries (B) which represent pulmonary thromboembolism. There is a wedge-shaped peripheral consolidation with a central lucency in the right lower lobe which represents a pulmonary infarction. C: indirect CT venography showed a filling defect (arrow) in the left femoral vein which represents deep vein thrombosis.

Fig. 3

Lung perfusion scan on admission. Lung perfusion scan revealed a diffuse decrease in perfusion in the right lung and a focal decrease in perfusion in the superior segment of the left lower lung (right : left=40 : 60). A: anterior view. B: posterior view.

Fig. 4

The hematologic profiles. A: in the hospital, marked eosinophilia and thrombocytopenia were noted with thromboembolic phenomena. B: after discharge, the eosinophila resolved spontaneously. WBC: white blood cell.