Lower extremity deep vein thrombosis in children

Area of Science:

• Vascular Medicine
• Pediatric Radiology
• Diagnostic Imaging

Background:

• Deep vein thrombosis (DVT) is a significant concern in both pediatric and adult populations.
• Clinical diagnosis of DVT in children is often unreliable, mirroring challenges seen in adults.
• Accurate diagnosis is crucial for appropriate management and prevention of complications.

Purpose of the Study:

• To evaluate the efficacy of leg venography in diagnosing deep vein thrombosis (DVT) in pediatric patients.
• To compare the diagnostic accuracy of venography with clinical assessment in children.
• To identify common clinical settings associated with DVT in the pediatric population.

Main Methods:

• Retrospective review of 113 leg venograms performed between 1969 and 1982.
• Focus on 68 venograms conducted in patients aged 16 years or younger.
• Utilized a tilt table method (Rabinov and Paulin) with patients in a 40-50 degree head-up incline, without tourniquets.

Main Results:

• 12 out of 68 (18%) venograms in children were positive for deep vein thrombosis (DVT).
• Identified clinical settings for pediatric DVT included post-catheterization, post-surgery, tumor/therapy, drug abuse, infection, and idiopathic causes.
• Complications observed included pulmonary infarction (three patients) and need for anticoagulation or IVC clipping (three patients).

Conclusions:

• Leg venography is the most accurate method for diagnosing deep vein thrombosis (DVT) in children.
• Clinical diagnosis of DVT in pediatric patients is not more accurate than in adults.
• Accurate venographic diagnosis is essential for guiding effective therapeutic strategies in pediatric DVT.