Aim Differential diagnosis challenges of pulmonary infarction in a male obese teenager with type 1 diabetes mellitus, therapeutic management and follow-up.

Material and Method Case report

Results Pulmonary infarction (PI) is an extremely rare event in pediatric patients and usually occurs through obstruction of a distal pulmonary artery. During COVID 19 pandemic, PI had a higher incidence in children diagnosed with Pediatric Multisystem Inflammatory Syndrome. We present the case of a 17-year-old obese teenager with a recent history of SARS CoV2 infection, diagnosed with type 1 diabetes mellitus and left lower lobe lung consolidation, without resolution under prolonged broad-spectrum antibiotic therapy. The differential diagnosis was difficult, and segmental pulmonary thromboembolism complicated with lung infarction of lower left lobe was detected by perfusion pulmonary scintigraphy (figure 1). Oral anticoagulant therapy with rivaroxaban was instituted by the pediatric cardiologist. Thrombophilia testing was performed with negative result.

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Abstract PP-001 Figure 1

Pulmonary perfusion scintigraphy - pulmonary infarction left lower lobe.

Subsegmental perfusion defect in the lingula (inferior segment) and segmental triangular hypoperfusion in the left lower lobe (anteromedial and lateral segments)

Conclusions Obesity, type 1 diabetes mellitus and COVID 19 are associated with an increased risk of thromboembolism. Pulmonary infarction is a very rare condition in children but must be suspected in the presence of underlying multiple risk factors. Prompt recognition and management of pulmonary thromboembolism and pulmonary infarction may lead to a decreased rate of mortality and pulmonary sequelae.