Venous claudication in a child with thrombophilia

Area of Science:

• Pediatric Thrombosis
• Vascular Medicine
• Hematology

Background:

• Deep venous thrombosis (DVT) is uncommon in active children, typically signaling an underlying inherited or acquired hypercoagulable state.
• Mechanical obstruction can also precipitate DVT. Standard initial management involves sequential heparin and warfarin anticoagulation.

Observation:

• A case of DVT in an adolescent female with elevated C-reactive protein and lupus anticoagulant is presented.
• The patient experienced venous claudication and severe lower-extremity swelling during ambulation.
• Initial conservative management with anticoagulation for over two weeks was followed by thrombolytic therapy, which was discontinued due to mild hematuria.

Findings:

• Despite early termination of thrombolytic therapy, a 2-year follow-up duplex scan demonstrated complete resolution of the iliofemoral thrombosis.
• Spontaneous DVT in pediatric patients often has an identifiable underlying etiology, distinguishing it from adult cases.

Implications:

• This case underscores the potential for successful resolution of pediatric DVT with appropriate, albeit sometimes complex, management strategies.
• Understanding the distinct etiologies of DVT in children compared to adults is crucial for effective diagnosis and treatment.
• Further research into the specific mechanisms and optimal treatment protocols for pediatric DVT is warranted.