儿童重症肺炎支原体肺炎合并心脏内血栓的临床特征与预后：一项单中心回顾性研究

doi:10.12372/jcp.2025.25e0342

Abstract

Abstract:

Objective To investigate the clinical features, therapeutic strategies, and outcomes in pediatric patients with severe Mycoplasma pneumoniae pneumonia (SMPP) complicated by intracardiac thrombosis. Methods A retrospective analysis was performed on the clinical records of 19 children diagnosed with SMPP and concurrent intracardiac thrombosis admitted between January 2020 and May 2024. Results Among the 19 children, 13 were boys and 6 were girls, with a median age of 8 (7-10) years. All children presented with fever and cough, and 11 (57.89%) exhibited additional extracardiac thrombotic events. Laboratory findings revealed elevated levels of C-reactive protein 58.91 (25.62-98.19) mg/L, lactate dehydrogenase 559 (442-791) U/L, and D - dimer 6.06 (3.44-7.52) mg/L. The median time from symptom onset to diagnosis was 12 (10-17) days, with all thrombi identified via echocardiography; the majority (n=14, 73.69%) were located in the right ventricle. Six patients underwent immediate surgical intervention due to hemodynamic instability (shock), large thrombus size (diameter>30 mm), or presence of multiple mobile thrombi with high embolic risk. Thirteen patients initially received anticoagulation therapy; seven showed marked reduction in thrombus burden, while one experienced embolization during early treatment and five required conversion to surgical thrombectomy due to inadequate response. During follow-up (3-5 months), none of the 11 surgically treated patients developed new thromboses or cardiac complications. Among the 8 non-surgical cases, 6 achieved complete thrombus resolution within 3 months, while one patient was lost to follow-up and one experienced embolization.Conclusion Pediatric SMPP with intracardiac thrombosis presents with nonspecific symptoms and carries a significant risk of systemic embolization. Dynamic monitoring of echocardiography and D-dimer levels during the first 1-2 weeks of illness is recommended for early detection. Prompt anticoagulant or surgical management is associated with favorable outcomes; however, therapeutic decisions should be individualized based on thrombus morphology, hemodynamic status, and embolic risk.

Key words: child, Mycoplasma pneumoniae, pneumonia, intracardiac, thrombus

CLC Number:

CHEN Dan, REN Jiaying, SUN Lifang, WEI Zhenghu, SUN Xiaomin. Clinical features and prognosis of severe Mycoplasma pneumoniae pneumonia combined with intracardiac thrombus in children: a single-center retrospective study[J].Journal of Clinical Pediatrics, 2026, 44(1): 17-24.

Figures/Tables 4

Table 1

Figure 1

Table 2

Diagnosis and treatment process of children with severe mycoplasma pneumoniae pneumonia complicated with intracardiac thrombosis"

患儿	确诊时程/d	栓子大小/mm	心脏栓子部位及活动度	心包积液	其他栓塞部位	抗凝治疗时间/d	手术取栓治疗	出院时栓子大小 /mm
1	12	18×16×10	右房内近下腔入口，活动度大	有（少量）	无	7	是	消失
2	13	12.6×8.7	右室内三尖瓣腱索处，活动度大	无	两下肺分支局部栓塞	4	无	消失
3	16	17.8×13.8×13.2	右室室间隔基底段	有（少量）	两肺下叶肺动脉部分分支	16	无	16.9×14.0×12.6
4	18	7.6×5.2	室间隔右室面近隔瓣处；附着于三尖瓣腱索	无	无	12	无	2.1×1.8
5	8	17.2×13.5	右室内三尖瓣腱索处,活动度大	有	无	10	无	16.0×9.5
6	13	37.1×17.4	右室内侧壁旁	无	无	0	是	消失
7	21	20×18×10	右室近心尖部室间隔处	有	无	6	是	消失
8	10	21.6×14.9	右心室腔内近心尖室间隔旁,活动度大	有	右肺动脉、分支及叶间动脉多发栓塞	0	是	消失
9	16	18×6×25	二尖瓣后瓣	无	脾栓塞、肾梗死	14	是	消失
10	14	15.6×13.3	右室内三尖瓣后叶腱索处	无	右下肺动脉栓塞	28	无	10.8×7.5
11	20	10.5×9.3	右室心尖处近右室流入道与流出道交界处	有	右肺下叶肺动脉部分分支	15	无	9.8×4.8
12	11	23×20×9、 13×10×7	右房内下腔静脉入口：附着于右房游离壁，活动度大，舒张期部分可进入三尖瓣口	无	无	0	是	消失
13	13	19.4×10.9、 20.7×6.7	右房内近三尖瓣隔瓣及后瓣瓣根处,可变形，活动度大	无	右下肺动脉分支	0	是	消失
14	10	14.7×12.4×37	右室腔内附着在隔瓣及腱索相移行处	无	左下肺动脉及部分分支	0	是	消失
15	10	11×9	右室腔内	无	无	8	无	9.6×9.5
16	8	14.6×7.8、 15×10×10	右室内隔后瓣腱索根部	无	双侧颈内静脉及上腔静脉	0	是	消失
17	14	20×16×10	右房近下腔静脉入口处，活动度大	有	无	10	是	消失
18	20	16×16×20	右室右外侧游离壁与前、后瓣腱索间	有（少量）	右肺上叶肺动脉	12	是	消失
19	10	8.9×8.6	右室内近室间隔侧	无	右肺下叶肺动脉分支	8	无	6.9×6.6

Table 2

Figure 2

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患儿	性别	年龄 /岁	入院时病程/d	肺炎支原体耐药基因	其他临床表现	WBC /×10⁹·L^-1	D-二聚体 /mg·L^-1	CRP /mg·L^-1	LDH /U·L^-1	抗磷脂抗体	肺坏死	胸腔积液
1	男	7	10	_	胸痛、气促	15.81	7.62	100.10	1 158	阴性	有	有（右侧）
2	男	12	9	_	咯血	6.07	6.06	17.41	422	-	无	无
3	女	10	7	阳性	胸痛	8.51	7.55	33.36	770	阳性	无	无
4	男	8	17	阳性	无	12.13	7.21	9.5	385	阴性	有	无
5	男	7	8	-	气促	16	7.52	30.39	442	-	无	有（右侧）
6	男	12	13	阳性	无	13.3	2.12	48.93	559	-	有	有（右侧）
7	男	7	21	阳性	气促	17.73	6.8	183.45	429	阳性	有	有（左侧）
8	女	10.1	10	阳性	呼吸困难、休克	22.62	10.23	58.91	993	-	有	有（双侧）
9	男	13	16	阳性	气促、胸痛	32.2	2.82	35.24	791	阴性	有	无
10	男	8	10	阳性	无	17.56	2.47	60.85	456	阳性	无	有（双侧）
11	男	4.6	20	阳性	无	14.91	3.44	101.24	535	阴性	有	无
12	女	9.8	11	阴性	无	17.91	4.44	86.27	818.8	-	有	有（左侧）
13	男	9.2	13	阳性	咯血、胸痛、呼吸困难	14.66	6.62	106.44	424.3	阴性	有	有（左侧）
14	男	7	3	阳性	呼吸困难	11.84	5.69	7.66	538	-	无	有（右侧）
15	男	8.8	9	阳性	无	30.26	5.09	17.74	746	-	有	有（左侧）
16	男	5.8	7	阳性	胸痛	22.45	4.26	48.25	859	-	无	有（左侧）
17	女	8	11	阳性	胸痛	29.38	8.83	98.19	656	-	有	无
18	女	4.3	8	阳性	无	22.24	2.1	58.93	680	-	有	无
19	女	5.1	3	阳性	无	8.08	2.18	25.62	552	-	无	无

Clinical features and prognosis of severe Mycoplasma pneumoniae pneumonia combined with intracardiac thrombus in children: a single-center retrospective study

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