Fatal embolic events in childhood

Lethal embolic events in children are an uncommon occurrence that may be first detected at autopsy. Emboli consist of thrombi, tumours, infective organisms, fat, air and foreign body material. The most significant circulations that may be obstructed are the pulmonary, coronary and cerebral. Rare conditions such as arteriovenous malformations may act as sources for emboli in children, and the brain is at particular risk from paradoxical embolism. The latter is facilitated by right to left communications in the heart such as atrial and ventricular septal defects and also from pulmonary vascular abnormalities such as hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) and arteriovenous fistulas. Iatrogenic causes of thromboembolism must be considered in children with indwelling central venous catheters and ventriculoatrial shunts. Although rare, embolic events do occur in children with lethal consequences. As the incidence of embolization in clinical settings has been increasing, due to improved survival of children with predisposing chronic conditions, it is likely that more of these cases will be the subject of forensic evaluation.