Thromboembolism and venous thrombosis of the deep veins in surgical children--an increasing challenge?

Abstract

Children share many known predisposing risk factors for venous thromboembolism and deep venous thrombosis but appears less common and is probably underestimated. Fatal pulmonary embolism is rare but may also be missed because of low level of clinical awareness. The aim of this study was to investigate children with thromboembolism of deep veins to evaluate risk factors and highlight their danger.

Methods: This was a retrospective review of all children (<13 years old) diagnosed with a venous thromboembolism (1993-2009). Clinical and radiologic features and any risk factors were documented. Venous thromboembolism was diagnosed on clinical suspicion together with compressive Doppler studies, spiral computed tomography, or magnetic resonance scan.

Results: Eighteen children with a consistent clinical picture were identified (painful unilateral limb swelling). Their mean age was 9.3 years with a male/female ratio of 3.5:1. Predisposing factors were identified in 17 (95%). These included infective conditions (n = 11), previous femoral line (n = 3), trauma (n = 2), and complicated appendicitis (n = 2). Chronic infective and inflammatory conditions included tuberculosis (n = 4), HIV (n = 3), staphylococcal septicemia (n = 2), and Takayasu arteritis (n = 1). Pulmonary embolism occurred in 5 (28%), and 1 presented later with a post-phlebitic leg. Elevated factor VIII was seen in 3.

Conclusion: This study identified an association with known risk factors in most children with venous thromboembolism and suggests that those with femoral venous access or ongoing chronic infective states (eg, TB/HIV) are particularly at risk.