Pulmonary Embolism in Adolescents: What Parents Need to Know

Pulmonary embolism (PE) is a condition in which one or more of the arteries in the lungs becomes blocked by a blood clot. It is important to recognize PE early because a large blood clot in the lungs can cause damage to the heart and in very rare cases PE can be a fatal condition in pediatric patients.

The most common symptom that patients with PE experience is chest pain, which is typically accompanied by shortness of breath. Less common symptoms include cough, a fast heart beat, and lightheadedness. 

What Causes PE?

In most cases, blood clots in children and adolescents occur in hospitalized patients. When PE presents in the outpatient setting, it is almost always in an adolescent patient with a current or recent risk factor for blood clots. The most common risk factors include a recent surgery, orthopedic injury, or prolonged car or airplane trip. 

Patients who are overweight or obese also have an increased risk of PE. In young women, contraceptives that contain estrogen (birth control pills, patch, and vaginal ring) as well as pregnancy, are also risk factors. 

What Are the Symptoms of PE?

Chest pain is a common complaint in children and adolescents and, fortunately, in most cases is not due to a serious cause such as a PE or heart condition.

The most common cause of chest pain in pediatric patients is chest wall pain due to the variety of muscles and joints in that area that can become sore or inflamed. Injury to the ribs, breastbone, or other bones in the chest or back can also cause chest pain. Colds, flus and pneumonias often cause chest pain due to muscle inflammation and/or soreness from persistent coughing. Acid reflux (heartburn) and anxiety are other common causes of chest pain.

Patients with PE will describe chest pain and/or shortness of breath that is persistent or worsening, often unlike symptoms they have ever experienced before and are not related to spicy foods or recent exercise. In many cases, a PE is caused by a blood clot that has traveled from the legs. Therefore, patients may be also having leg pain and swelling at the time they present with chest pain, or they may have experienced those symptoms in the recent past.

Because there are so many other causes of chest pain, and because PE is rare in pediatric patients, it is important for families to alert health care providers if their child or teenager is experiencing possible symptoms of PE and has a risk factor for blood clots. Families should report any recent surgery, orthopedic injury, or prolonged travel, or if their daughter has started a contraceptive agent. Alerting health care providers about a family history of blood clots is also very helpful.