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Post-thrombotic syndrome
Insights
Post-thrombotic syndrome (PTS) can affect children after deep venous thrombosis (DVT), often linked to central venous lines. Early recognition is crucial for managing this disabling condition in pediatric patients.
Area of Science:
- Pediatric Medicine
- Vascular Medicine
- Clinical Case Studies
Background:
- Post-thrombotic syndrome (PTS) is a recognized complication of deep venous thrombosis (DVT) in adults.
- PTS has recently been identified as a potential complication in pediatric patients.
- Central venous lines (CVLs) are increasingly used in children, posing a risk for DVT and subsequent PTS.
Observation:
- Three pediatric cases of symptomatic PTS following CVL use are presented.
- In two cases, acute thrombosis symptoms were absent, highlighting a subtle onset.
- Clinical presentation includes pain, swelling, and brawny induration, similar to adult PTS.
Findings:
- Literature review indicates an estimated 7-12% incidence of PTS in children post-DVT.
- PTS is confirmed as a significant complication of DVT in the pediatric population.
- The long-term effects of PTS on growing limbs remain unknown.
Implications:
- Paediatricians must be vigilant for PTS in at-risk children, including those with malignancy, congenital heart disease, or prior CVLs.
- Awareness is critical even when acute DVT is not documented.
- Early identification and management are essential to mitigate the disabling effects of PTS in children.
Abstract:
Post-thrombotic syndrome (PTS) is a potentially disabling complication occurring in up to 67% of adult patients following deep venous thrombosis (DVT). PTS has recently been recognised in children. We present three cases of symptomatic PTS in children, which occurred following the use of central venous lines (CVLs). In two cases, no symptoms of acute thrombosis were noted. The cases highlight the clinical presentation of this syndrome. A review of the literature revealed two reports describing PTS occurring in children following DVT with an estimated incidence of 7-12%. It is concluded that PTS is an important complication of DVT in children. The clinical findings of pain, swelling, and brawny induration are similar to adult patients. The effect on growing limbs is not known. Paediatricians should be aware of the potential of PTS in all children who are at risk of DVT, including patients with malignancy, congenital heart disease, and children who have had previous CVLs, even in the absence of documented acute DVT.