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      Deep Vein Thrombosis in Children

      case-report

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          Abstract

          We describe a rare case of deep vein thrombosis (DVT) in children, highlight the importance of early diagnosis of rare disease with potential complications. In a 5 year old boy presented with persistent leg pain without any obvious cause. Detailed investigation led to diagnosis of DVT. As there are common differential diagnoses for leg pain in children, pediatricians usually have a low index of suspicious of DVT in children. This case highlight that paediatricians must consider DVT in their differential diagnosis when children present with leg pain.

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          Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE.

          M David, N Barnard, M-L Brisson … (1994)
          Deep vein thrombosis (DVT) and pulmonary embolism (PE) occur in pediatric patients; however, the incidence, associated morbidity, and mortality are unknown. A Canadian registry of DVT and PE in children (ages 1 month to 18 years) was established July 1, 1990 in 15 tertiary-care pediatric centers. One-hundred thirty-seven patients were identified prospectively and are the subject of this report. The incidence of DVT/PE was 5.3/10,000 hospital admissions or 0.07/10,000 children in Canada. Infants under 1 year old and teenagers predominated with equal numbers of both sexes. DVT were located in the upper (n = 50) and lower (n = 79) venous system, or as PE alone (n = 8). Central venous lines (CVLs) were present in approximately 33% of children with DVT (n = 45). Associated conditions were present in 96% of children and 90% of children had two or more associated conditions for DVT. DVT was diagnosed by venography (n = 83), duplex ultrasound (n = 37), and other combinations (n = 17). Twenty-two of the 31 ventilation/perfusion scans performed were interpreted as high-probability scans for PE. Therapy consisted of heparin (n = 115), thrombolysis (n = 15), surgical removal of a CVL or thrombus (n = 22), and oral anticoagulant therapy (n = 103). Significant bleeding complications did not occur. However, three (2.2%) children died as a direct consequence of their thromboembolic disease; DVT reoccurred in 23 children and postphlebitic syndrome (PPS) occurred in 26. In conclusion, DVTs occur in a significant number of hospitalized children with a mortality of 2.2%. Complications are not hemorrhagic, but thrombotic, and characterized by PE, recurrent disease, and PPS. In contrast to adults, the upper venous system is frequently affected because of the use of CVLs. The frequency of DVT/PE justifies controlled trials of primary prophylaxis in high-risk groups, and therapeutic trials to determine optimal treatment.
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            Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands.

            H Meijers-Heijboer, John Heijmans, Kate Peters … (2001)
            To study the incidence, signs and symptoms, diagnostic tests, risk factors, therapy, and complications of pediatric venous thromboembolism (VTE) in The Netherlands. A prospective 2-year registry of VTE in children aged < or = 18 years. Ninety-nine patients were registered. The annual incidence of VTE was 0.14/10,000 children, 35% of whom were symptom free. Almost half of the patients were newborns. Neonatal VTE was almost exclusively catheter related, located in the upper venous system, and asymptomatic. In older children VTE was catheter related in approximately one third and more often was located in the lower venous system. In 85% of all patients, thrombosis developed while the patient was in the hospital. Diagnosis was usually made by ultrasonography. In 98% of all patients, at least 1 risk factor was present. Congenital prothrombotic disorders were more often present in older children (21%) than in neonates (6%). A variety of treatment modalities were used. Morbidity consisted of bleeding (7%) and recurrent thrombosis (7%). Two children died as result of VTE. VTE is mostly diagnosed in hospitalized children, especially sick newborns with central venous catheters and older children with a combination of risk factors. Primary prevention, optimal treatment, and long-term outcome of pediatric symptomatic and asymptomatic VTE need to be studied.
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              Clinical probability score and D-dimer estimation lack utility in the diagnosis of childhood pulmonary embolism.

              Fernando G S L Brandão, S. Williams, Walter Kahr … (2009)
              Childhood pulmonary embolism (PE) causes significant mortality and evidence suggests that it is under-diagnosed. Clinical probability scores and D-dimer estimation to assess pre-test probability have not been studied in children with suspected PE. This retrospective cohort study evaluated Wells simplified probability score for PE in 50 children with PE and 25 PE negative control patients, and D-dimer values in 27 PE positive and 12 PE negative children. PE positive and PE negative groups had similar rates of risk factors for venous thromboembolism (VTE). Wells simplified probability score showed a small difference between PE positive and PE negative children (median score: PE positive, 4.5; PE negative, 4; P = 0.009), children with PE are more likely to obtain a 'PE likely' score (score > 4), P = 0.012. The difference was of slightly greater significance when the Wells score was adjusted to account for pediatric normal ranges for heart rate, P = 0.007, and signs/symptoms of upper limb DVT, P = 0.006. Children with PE were as likely as PE negative patients to have a D-dimer value within the normal range (PE positive, 15%; PE negative, 25%; P = 0.654). A combination of a 'PE unlikely' score and normal D-dimer value occurred in 1/12 (8%) of PE negative children. The Wells clinical probability score and D-dimer estimation may lack utility in the determination of pre-test probability of PE in children. Validation of a pediatric clinical probability score, incorporating D-dimer estimation, by prospective study, would be difficult as a result of the rarity of childhood PE.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pediatr Rep
                Journal ID (iso-abbrev): Pediatr Rep
                Journal ID (publisher-id): PR
                Title: Pediatric Reports
                Publisher: PAGEPress Publications
                ISSN (Print): 2036-749X
                ISSN (Electronic): 2036-7503
                Publication date (Electronic): 19 June 2013
                Publication date Collection: 13 June 2013
                Volume: 5
                Issue: 2
                Pages: 48-49
                Affiliations
                Department of Pediatrics, Whiston Hospital , Whiston, Merseyside, UK
                Author notes
                Department of Pediatrics, Whiston Hospital, Whiston, Merseyside, UK. Tel. +44.772.5867054. E-mail: abidcmc@ 123456yahoo.com
                Conflict of interests: the authors declare no potential conflict of interests.
                This work is licensed under a Creative Commons Attribution NonCommercial 3.0 License (CC BYNC 3.0).
                Article
                DOI: 10.4081/pr.2013.e12
                PMC ID: 3718230
                PubMed ID: 23904967
                SO-VID: 3f134035-e03c-4358-b5b8-8e6d1032a663
                Copyright © ©Copyright K. Aabideen et al.,
                History
                Date received : 30 August 2011
                Date accepted : 16 December 2011
                Date revision received : 16 December 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 2
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Pediatrics
                Keywords: children,thrombosis,deep vein
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: children, thrombosis, deep vein

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