Sonographic evaluation of suspected pediatric vascular diseases

Sonographic studies on 52 children with suspected peripheral vascular disease examined between January 1988 and December 1989 were retrospectively reviewed. A technique for examining the jugular, subclavian veins, and superior vena cava (SVC) was developed and is described. The technique for examining the extremities in the child is similar to the adult except higher frequency transducers are used. Twenty-six patients had normal examinations. Twenty-six examinations were abnormal with arterial or venous thrombosis in patients with central lines [10 patients], deep venous thrombosis in patients with painful swollen extremities [9], arterial pseudoaneurysm as a complication of vascular punctures [1], arteriovenous fistula in a renal dialysis patient [1], dilated vessel presenting as a mass [1], compression of a vessel by a mass resulting in extremity swelling [2]. Two patients had other etiologies causing their symptoms and diagnosed on sonography including an infected hematoma and a hip effusion. The advantages of sonography include no contrast material necessary, nonionizing radiation, qualitative and quantitative characterization of vascular flow is possible with Doppler, and the examination can be performed portably. Color Doppler aided in localizing the vessel, visualizing the thrombus, as well as decreasing exam time. Doppler sonography usually answered the clinical question and made further invasive procedures such as venograms and arteriograms unnecessary.