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Caval thrombectomy for severe staphylococcal osteomyelitis
1Department of Paediatric Surgery, Starship Children's Health, Auckland, New Zealand.
Insights
Inferior vena cava thrombosis in children can occur with staphylococcal osteomyelitis. Caval thrombectomy may improve outcomes in these critical cases, as suggested by a survivor's recovery.
Area of Science:
- Pediatric Infectious Diseases
- Vascular Surgery
- Hematology
Background:
- Staphylococcal osteomyelitis can lead to severe complications in children.
- Septic embolization can cause widespread infections, including pneumonia.
- Inferior vena cava (IVC) thrombosis is a rare but serious complication.
Observation:
- Two pediatric cases of acute staphylococcal osteomyelitis with associated IVC thrombosis are presented.
- Both patients had diffuse bilateral staphylococcal pneumonia.
- Similarities in illness and management were noted between the two cases.
Findings:
- One child with left femoral osteomyelitis and IVC thrombosis survived.
- The surviving child underwent a caval thrombectomy during the acute phase of illness.
- The other child, with left iliac osteomyelitis, did not undergo thrombectomy and did not survive.
Implications:
- Caval thrombectomy may be a crucial intervention for pediatric IVC thrombosis secondary to staphylococcal infections.
- Early surgical intervention might improve survival rates in complex pediatric vascular emergencies.
- This case series highlights the potential link between severe staphylococcal infections and thrombotic events in children.
Abstract:
Two children are presented in whom thrombosis of the inferior vena cava developed in association with an acute staphylococcal osteomyelitis. One case involved the left femur and the other the left ileum. Both children had diffuse bilateral staphylococcal pneumonia from presumed septic embolization. There were close similarities between their illness and management, except that the child who survived underwent a caval thrombectomy in the acute phase of her illness. It is hypothesized that the thrombectomy played an important role in her recovery.