Acute Pulmonary Embolism Associated with Transposition of the Inferior Vena Cava in a 14-year-old Boy

Idiopathic venous thromboembolism (VTE) and pulmonary embolism (PE) are relatively infrequent in the pediatric population but are almost always associated with an underlying disease or risk factors, such as congenital or acquired coagulation abnormalities, autoimmune disorders, or malignancies. In the pediatric emergency department, VTE, and particularly, PE, are often less considered in differential diagnoses because of their low incidence. On the other hand, a delayed diagnosis can result in serious morbidity and mortality. Therefore, even if there are no well-known risk factors, it is important to consider the possibility of PE, whenever there are suspicious symptoms and signs. The transposition of the inferior vena cava (IVC) is one of the major anatomical variants among the spectrum of IVC malformations. Although most IVC malformations are clinically silent and are discovered incidentally on radiographs, they are associated with PE in rare cases. In the pediatric population, no cases of transposition of the IVC that was discovered by acute PE have been reported. We report a case of acute PE associated with a transposition of the IVC in a 14-year-old boy without intra-cardiac anomalies or coagulation abnormalities.

A case of strongloidiasis with hyperinfection syndrome

A 73-year-old Korean male was admitted to Jeil hospital with clinical complaints of backache, cough, sputum, vomiting and diarrhea. He had a history of long term administration of prednisolone. At admission he was comatose and showed generalized pitting edema and anasarca. Laboratory data revealed leukocytosis, hyperproteinemia with hypoalbuminemia, sepsis, anemia and brown-colored urine. Stool examination revealed rhabditiform nematode larvae. By fecal cultivation, filariform larvae of Strogyloides were obtained and the patient was diagnosed as hyperinfection syndrome due to S. stercoralis infection. On the 3rd day of hospitalization, albendazole treatment was started and continued for 4 days. On the 7th dsy of hospitalization, sputum revealed filariform larvae. Total 619 parasitic adult females, expelled by chemotherapy, were collected from the diarrheal stool. However, the patient was discharged hopelessly and died at home.