Тромбоэмболия легочной артерии у детей: обзор литературы

Тромбоэмболия легочной артерии (ТЭЛА) – жизнеугрожающее состояние, характеризующееся закупоркой одной или нескольких ветвей легочной артерии тромбом. Данное состояние может протекать как бессимптомно, так и с характерными проявлениями и быстрым летальным исходом. ТЭЛА – достаточно редкая патология в детской популяции, поэтому постановка точного диагноза может быть затруднительна для врача. В данном обзоре собраны и обобщены имеющиеся данные о ТЭЛА у детей. В статье рассмотрены эпидемиология, этиология, факторы риска, патогенез, клиническая картина, диагностика и лечение.

1. Andrew M., David M., Adams M., Ali K., Anderson R., Barnard D., Bernstein M., Brisson L., Cairney B., DeSai D., Grant R., Israels S., Jardine L., Luke B., Massicotte P., Silva M. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994;83(5):1251–7. doi: 10.1182/blood.V83.5.1251.1251.

2. van Ommen C.H., Heijboer H., Büller H.R., Hirasing R.A., Heijmans H.S., Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001;139(5):676–81. doi: 10.1067/mpd.2001.118192.

3. Brandão L.R., Labarque V., Diab Y., Williams S., Manson D.E. Pulmonary embolism in children. Semin Thromb Hemost. 2011;37(7):772–85. doi: 10.1055/s-0031-1297168.

4. Biss T.T., Brandão L.R., Kahr W.H., Chan A.K., Williams S. Clinical features and outcome of pulmonary embolism in children. Br J Haematol. 2008;142(5):808–18. doi: 10.1111/j.1365-2141.2008.07243.x.

5. Ramiz S., Rajpurkar M. Pulmonary embolism in children. Pediatr Clin North Am. 2018;65(3):495–507. doi: 10.1016/j.pcl.2018.02.002.

6. Patocka C., Nemeth J. Pulmonary embolism in pediatrics. J Emerg Med. 2012;42(1):105–16. doi: 10.1016/j.jemermed.2011.03.006.

7. Raffini L., Huang Y.S., Witmer C., Feudtner C. Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001–8. doi: 10.1542/peds.2009-0768.

8. O’Brien S.H., Stanek J.R., Witmer C.M., Raffi ni L. The continued rise of venous thromboembolism across US Children’s Hospitals. Pediatrics. 2022;149(3):e2021054649. doi: 10.1542/peds.2021-054649. PMID: 35156127.

9. Williams S., Wang M. Pulmonary embolism. Pediatric Thrombotic Disorders. 2015:16–32. doi: 10.1017/CBO9781139028882.003.

10. Thacker P.G., Lee E.Y. Pulmonary embolism in children. AJR Am J Roentgenol. 2015;204(6):1278–88. doi: 10.2214/AJR.14.13869.

11. Rajpurkar M., Warrier I., Chitlur M., Sabo C., Frey M.J., Hollon W., Lusher J. Pulmonary embolism-experience at a single children’s hospital. Thromb Res. 2007;119(6):699–703. doi: 10.1016/j.thromres.2006.05.016.

12. Rajpurkar M., Huang Y.V., Raffini L. Additional analysis of pediatric pulmonary embolism using the Pediatric Health Information System database. Blood Adv. 2019;3(17):2604–7. doi: 10.1182/bloodadvances.2019000071.

13. Lira L.A.S., Celeste D.M., Garanito M.P., Carneiro J.D.A. Pulmonary embolism in pediatrics: a 10-year experience from a tertiary center in Brazil. Hematol Transfus Cell Ther. 2023;45 Suppl 2(Suppl 2):S85–90. doi: 10.1016/j.htct.2022.02.005.

14. Dijk F.N., Curtin J., Lord D., Fitzgerald D.A. Pulmonary embolism in children. Paediatr Respir Rev. 2012;13(2):112–22. doi: 10.1016/j.prrv.2011.09.002.

15. Stein P.D., Kayali F., Olson R.E. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004;145(4):563–5. doi: 10.1016/j.jpeds.2004.06.021.

16. Krmpotic K., Ramsay L., McMullen S., Chan A.K.C., Plint A.C., Moorehead P. Pediatric pulmonary thromboembolism: a 3-year Canadian Pediatric Surveillance Program study. J Thromb Haemost. 2024;22(5):1366–71. doi: 10.1016/j.jtha.2024.01.005.

17. Rueda-Camino J.A., Sabrido-Bermúdez G., Barba-Martín R. Trends and risk factors of pediatric venous thromboembolism in Spain: a nationwide study from 2016 to 2023. J Clin Med. 2025;14(11):3950. doi: 10.3390/jcm14113950.

18. Buck J.R., Connors R.H., Coon W.W., Weintraub W.H., Wesley J.R., Coran A.G. Pulmonary embolism in children. J Pediatr Surg. 1981;16(3):385–91. doi: 10.1016/s0022-3468(81)80700-2.

19. Ye F., Tekiner H., Yale E.S., Mazza J.J., Stalvey C., Yale S.H. Venothromboembolic signs and medical eponyms: Part I. Thromb Res. 2019;182:194–204. doi: 10.1016/j.thromres.2019.06.012.

20. Huisman M.V., Büller H.R., ten Cate J.W., van Royen E.A., Vreeken J., Kersten M.J., Bakx B. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest. 1989;95(3):498–502. doi: 10.1378/chest.95.3.498.

21. Monagle P., Adams M., Mahoney M., Ali K., Barnard D., Bernstein M., Brisson L., David M., Desai S., Scully M. F., Halton J., Israels S., Jardine L., Leaker M., McCusker P., Silva M., Wu J., Anderson R., Andrew M., Massicotte M.P. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res. 2000;47(6):763–6. doi: 10.1203/00006450-200006000-00013.

22. Obeagu E.I. Pediatric thrombosis: Risk factors, diagnosis, and prevention strategies. Medicine (Baltimore). 2025;104(29):e43370. doi: 10.1097/MD.0000000000043370.

23. Carter C., Gent M. The epidemiology of venous thrombosis. In: Colman R.W., Hirsh J., Marder V.J., Salzman E.W., eds. Hemostasis and thrombosis. basic principles and clinical practice. Philadelphia, PA: Lippincott, 1982. P. 805.

24. Giglia T.M., Massicotte M.P., Tweddell J.S., Barst R.J., Bauman M., Erickson C.C., Feltes T.F., Foster E., Hinoki K., Ichord R.N., Kreutzer J., McCrindle B.W., Newburger J.W., Tabbutt S., Todd J.L., Webb C.L.; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Stroke Council. Prevention and treatment of thrombosis in pediatric and congenital heart disease: a scientifi c statement from the American Heart Association. Circulation. 2013;128(24):2622–703. doi: 10.1161/01.cir.0000436140.77832.7a.

25. Pelland-Marcotte M.C., Pole J.D., Kulkarni K., Athale U., Stammers D., Sabapathy C., Halparin J., Brandão L.R., Sung L. Thromboembolism incidence and risk factors in children with cancer: a population-based cohort study. Thromb Haemost. 2018;118(9):1646–55. doi: 10.1055/s-0038-1668543.

26. Bernstein D., Coupey S., Schonberg S.K. Pulmonary embolism in adolescents. Am J Dis Child 1986;140(7):667–71. doi: 10.1001/archpedi.1986.02140210065028.

27. Monagle P., Azzam M., Bercovitz R., Betensky M., Bhat R., Biss T., Branchford B., Brandão L.R., Chan A.K.C., Faustino E.V.S., Jaffray J., Jones S., Kawtharany H., Kerlin B.A., Kucine N., Kumar R., Male C., Pelland-Marcotte M.C., Raffini L., Raulji C., Sartain S.E., Takemoto C.M., Tarango C., van Ommen C.H., Velez M.C., Vesely S.K., Wiernikowski J., Williams S., Wilson H.P., Woods G., Zia A., Mustafa R.A. American Society of Hematology/International Society on Thrombosis and Haemostasis 2024 updated guidelines for treatment of venous thromboembolism in pediatric patients. Blood Adv. 2025;9(10):2587–636. doi: 10.1182/bloodadvances.2024015328.

28. van Rooden C.J., Schippers E.F., Barge R.M., Rosendaal F.R., Guiot H.F., van der Meer F.J., Meinders A.E., Huisman M.V. Infectious complications of central venous catheters increase the risk of catheterrelated thrombosis in hematology patients: a prospective study. J Clin Oncol. 2005;23(12):2655–60. doi: 10.1200/JCO.2005.05.002. 29. Lee A.Y. Cancer and thromboembolic disease: pathogenic mechanisms. Cancer Treat Rev. 2002;28(3):137–40. doi: 10.1016/s0305-7372(02)00044-0.

29. Samji N., Bhatt M.D., Kulkarni K. Challenges in management of VTE in children with cancer: risk factors and treatment options. Front Pediatr. 2022;10:855162. doi: 10.3389/fped.2022.855162.

30. Huang J., Yang J., Ding J. Pulmonary embolism associated with nephrotic syndrome in children: a preliminary report of 8 cases. Chin Med J (Engl). 2000;113(3):251–3.

31. Hoyer P.F., Gonda S., Barthels M., Krohn H.P., Brodehl J. Thromboembolic complications in children with nephrotic syndrome. Risk and incidence. Acta Paediatr Scand. 1986;75(5):804–10. doi: 10.1111/j.1651-2227.1986.tb10294.x.

32. Селютина Н.С., Кригер О.В., Морозов Ю.Е. Тромбоэмболия легочной артерии у ребенка грудного возраста. Судебно-медицинская экспертиза. 2013;56(1):56–7. [Selyutina N.S., Kriger O.V., Morozov Yu.Ye. Pulmonary thromboembolism in a breastfeeding child. Sudebno-meditsinskaya ekspertiza = Forensic Medical Expertise. 2013;56(1):56–7. (In Russ.)].

33. Дроздова А.И. Тромбоэмболия легочной артерии у двух девочек-подростков. Клинические случаи. Тезисы X Общероссийского конференц-марафона «Перинатальная медицина: от прегравидарной подготовки к здоровому материнству и детству» и III Научно-практической конференции «Педиатрия XXI века: новые парадигмы в современных реалиях», Санкт-Петербург, 15–17 февраля 2024 г. М: Редакция журнала StatusPraesens, 2024. С.

34. Белоусова Т.В., Лоскутова С.А., Затолокина А.О., Плюшкин В.А. Тромбоэмболия легочной артерии в практике педиатра на примере клинического случая. Педиатрия. Consilium Medicum. 2022;3:239–43. doi: 10.26442/26586630.2022.3.201811.

35. Цыганков А.Е., Афуков И.И., Власова А.В., Глазырина А.А., Ларина Л.Е., Гитиновасов Р.С., Курбанова С.Х., Чудина О.С. Жизнеугрожающие тромботические осложнения у детей в отделении реанимации и интенсивной терапии. Детская хирургия. 2021;25(6):386–91. doi: 10.55308/1560-9510-2021-25-6-386-391.

36. Navanandan N., Stein J., Mistry R.D. Pulmonary embolism in children. Pediatr Emerg Care. 2019;35(2):143–51. doi: 10.1097/PEC.0000000000001730.

37. Alsabri M., Attalla A., Abdelrahman S.T., Elsnhory A.B., Abo-Elnour D.E., Aderinto N., Ukoaka B.M., Alqeeq B.F., Gamboa L.L. Systematic review of case series and case reports on pediatric pulmonary embolism. J Med Case Rep. 2025;19(1):76. doi: 10.1186/s13256-025-05084-7.

38. van Ommen C.H., Peters M. Acute pulmonary embolism in childhood. Thromb Res. 2006;118(1):13–25. doi: 10.1016/j.thromres.2005.05.013.

39. Keskin H.V., Ozcelik N., Senturk Topaloglu E., Ozyurt S., Gumus A., Sahin U. Which is more valuable in the diagnosis of pulmonary thromboembolism? The Wells Score, the Revised Geneva Score, or the Padua Score? Life (Basel). 2025;15(7):1115. doi: 10.3390/life15071115.

40. Barnes G.D., Muzikansky A., Cameron S., Giri J., Heresi G.A., Jaber W., Wood T., Todoran T.M., Courtney D.M., Tapson V., Kabrhel C. Comparison of 4 acute pulmonary embolism mortality risk scores in patients evaluated by pulmonary embolism response teams. JAMA Netw Open. 2020;3(8):e2010779. doi: 10.1001/jamanetworkopen.2020.10779.

41. Kanis J., Hall C.L., Pike J., Kline J.A. Diagnostic accuracy of the D-dimer in children. Arch Dis Child. 2018;103(9):832–4. doi: 10.1136/archdischild-2017-313315.

42. Zaidi A.U., Hutchins K.K., Rajpurkar M. Pulmonary embolism in children. Front Pediatr. 2017;5:170. doi: 10.3389/fped.2017.00170. 44. Babyn P.S., Gahunia H.K., Massicotte P. Pulmonary thromboembolism in children. Pediatr Radiol. 2005;35(3):258–74. doi: 10.1007/s00247-004-1353-y.

43. Rajpurkar M., Williams S., Goldenberg N.A., Van Ommen C.H., Chan A.K.C., Thomas R., Biss T. Results of a multinational survey of diagnostic and management practices of thromboembolic pulmonary embolism in children. Thromb Res. 2019;183:98–105. doi: 10.1016/j.thromres.2019.08.002.

44. Stein P.D., Fowler S.E., Goodman L.R., Gottschalk A., Hales C.A., Hull R.D., Leeper K.V. Jr., Popovich J. Jr., Quinn D.A., Sos T.A., Sostman H.D., Tapson V.F., Wakefi eld T.W., Weg J.G., Woodard P.K. PIOPED II Investigators. Multidetector computed tomography for acute pulmonary embolism. N Engl J Med. 2006;354(22):2317–27. doi: 10.1056/NEJMoa052367.

45. Tang C.X., Schoepf U.J., Chowdhury S.M., Fox M.A., Zhang L.J., Lu G.M. Multidetector computed tomography pulmonary angiography in childhood acute pulmonary embolism. Pediatr Radiol. 2015;45(10):1431–9. doi: 10.1007/s00247-015-3336-6.

46. Yanagawa M., Gyobu T., Leung A.N., Kawai M., Kawata Y., Sumikawa H., Honda O., Tomiyama N. Ultra-low-dose CT of the lung: effect of iterative reconstruction techniques on image quality. Acad Radiol. 2014;21(6):695–703. doi: 10.1016/j.acra.2014.01.023.

47. Liu A.Z., Winant A.J., Lu L.K., Rameh V., Byun K., Lee E.Y. Computed tomography and magnetic resonance imaging for pulmonary embolus evaluation in children: up-to-date review on practical imaging protocols. Pediatr Radiol. 2023;53(7):1260–9. doi: 10.1007/s00247-022-05451-2.

48. Stein P.D., Chenevert T.L., Fowler S.E., Goodman L.R., Gottschalk A., Hales C.A., Hull R.D., Jablonski K.A., Leeper K.V. Jr., Naidich D.P., Sak D.J., Sostman H.D., Tapson V.F., Weg J.G., Woodard P.K. PIOPED III (Prospective Investigation of Pulmonary Embolism Diagnosis III) Investigators. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med. 2010;152(7):434–43, W142–3. doi: 10.7326/0003-4819-152-7-201004060-00008.

49. Monagle P., Chan A.K.C., Goldenberg N.A., Ichord R.N., Journeycake J.M., Nowak-Göttl U., Vesely S.K. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e737S–801S. doi: 10.1378/chest.11-2308.

50. Tarango C., Manco-Johnson M.J. Pediatric thrombolysis: a practical approach. Front Pediatr. 2017;6;5:260. doi: 10.3389/fped.2017.00260.

51. Kawtharany H., Azzam M., Alkhader A., Betensky M., Hamarsha Q., Abou Zeid H.K., Mansour R., Tabak C., Patel P., Baghdadi S.L., Bercovitz R.S., Bhat R., Biss T., Branchford B.R., Brandão L.R., Chan A.K.C., Faustino E.V.S., Jaff ray J., Jones S., Kerlin B.A., Kucine N., Kumar R., Male C., Pelland-Marcotte M.C., Raffini L., Raulji C.M., Sartain S.E., Takemoto C.M., Tarango C., van Ommen C.H., Velez M.C., Vesely S.K., Wiernikowski J., Williams S., Wilson H.P., Woods G., Zia A., Monagle P., Mustafa R.A. Efficacy and safety of thrombolysis for pediatric venous thromboembolism: a systematic review and meta-analysis. Blood Adv. 2025;9(21):5512–27. doi: 10.1182/bloodadvances.2025017058.

52. Федеральные клинические рекомендации по диагностике, профилактике и лечению тромбозов у детей и подростков. М.: Национальное общество детских онкологом и гематологов, ФГБУ «ФНКЦ ДГОИ им. Дмитрия Рогачева» Минздрава России, 2015. С. 52–62.

53. Woods G.M., Kim D.W., Paden M.L., Viamonte H.K. Thrombolysis in Children: a case report and review of the literature. Front Pediatr. 2022;9:814033. doi: 10.3389/fped.2021.814033.

54. Findlay M.C., Grandhi R., Nelson J.R., Lucke-Wold B., Chowdhury M.A.B., Hoh B.L., Steinberg J., Santiago-Dieppa D., Khalessi A., Ikeda D.S., Ravindra V.M. How do children fare compared with adults? Comparing relative outcomes after thrombectomy for acute ischemic stroke due to large-vessel occlusion. J Stroke Cerebrovasc Dis. 2023;32(11):107350. doi: 10.1016/j.jstrokecerebrovasdis.2023.107350.