Unprovoked Saddle Pulmonary Embolism in a 12-Year-Old Child Requiring Open Surgical Pulmonary Embolectomy: A Case Report and Literature Review

BackgroundVenous thromboembolism (VTE) in childhood is an uncommon event compared with adults.The estimated incidence of pediatric PE is less than 1 per 100,000 annually [1].Most cases are provoked by identifiable factors including central venous catheters, oncological disease, or systemic infection [2].Reports of unprovoked pediatric PE are scarce in the literature, and their rarity makes recognition challenging.We present a case of unprovoked PE in a 12-year-old child, followed by a review of potential underlying mechanisms and implications for clinical care. Case PresentationA previously healthy 12-year-old child presented with acute onset pleuritic chest pain and dyspnoea.There was no history of recent infection, trauma, immobilisation, surgery, or use of central venous catheters.Past medical and family history were unremarkable, with no known thrombophilia.On examination, the patient was tachycardic with oxygen desaturation but haemodynamically stable.Chest radiograph was unremarkable.CT pulmonary angiography revealed filling defects within the segmental branches of the right pulmonary artery, consistent with acute pulmonary embolism.Laboratory investigations including complete blood count, renal and liver function were normal.A full thrombophilia screen was performed, including protein C, protein S, antithrombin levels, Factor V Leiden mutation, and prothrombin G20210A mutation, all of which were within normal limits.No underlying inflammatory or systemic disorder was identified.The patient was commenced on low-molecular-weight heparin and transitioned to a direct oral anticoagulant.Clinical symptoms improved, and follow-up imaging demonstrated resolution of the embolus.The patient continues on anticoagulation with close outpatient followup. DiscussionPulmonary embolism (PE) in childhood is rare, with an estimated annual incidence of 0.9 per 100,000 children [1].Most