Venous Thromboembolism in Pediatric Musculoskeletal Infections: Diagnostic Challenges in a Resource-Limited Setting

Venous thromboembolism is a recognized but often underdiagnosed complication of pediatric musculoskeletal infections, particularly in low-resource settings where access to Doppler ultrasonography, magnetic resonance imaging, and computed tomography pulmonary angiography (CTPA) remains limited. We describe two previously healthy children who developed deep vein thrombosis with pulmonary embolism secondary to acute musculoskeletal infection. Both presented initially with fever, severe limb pain, and rapidly progressive swelling, followed by the onset of tachypnoea and respiratory compromise. Doppler ultrasonography confirmed lower-limb deep vein thrombosis in both cases, while computed tomography pulmonary angiography in one child demonstrated bilateral pulmonary emboli with pulmonary infarction. In the second child, pulmonary embolism was diagnosed based on clinical deterioration and characteristic chest radiographic findings in the absence of available computed tomography. Both children were managed successfully with intravenous antibiotics, therapeutic anticoagulation, and surgical drainage where indicated, although one required mechanical ventilation in the pediatric intensive care unit. These cases highlight the diagnostic challenges of venous thromboembolism complicating musculoskeletal infection in resource-limited settings and emphasize the importance of maintaining a high index of suspicion when limb swelling worsens or respiratory symptoms develop. Bedside Doppler ultrasonography and timely referral remain essential tools for reducing morbidity when advanced imaging is inaccessible.