Pediatric Venous Thrombosis Diagnosis

Ultrasound (US) is the initial imaging modality of choice for diagnosing deep venous thrombosis (DVT) in children
Compression US can help diagnose DVT by assessing for non-compressibility of the vein
Doppler US can evaluate blood flow and detect thrombus
Other imaging modalities that may be used:
- Contrast-enhanced US or CT scan for central venous thrombosis
- Magnetic Resonance Angiography (MRA) or Venography for complex or distal thrombosis

Clinical presentation varies depending on the age and location of the thrombosis
Signs and symptoms may include:
- Pain, swelling, or tenderness in the affected limb
- Palpable cord or mass
- Decreased mobility or activity
- Cyanosis or pallor
Physical exam should include:
- Inspection for swelling, erythema, or discoloration
- Palpation for tenderness or a palpable cord
- Assessment of peripheral pulses

Laboratory tests may help identify underlying causes or risk factors:
- Complete Blood Count (CBC) to evaluate for infection or inflammation
- Blood chemistry tests to evaluate for underlying medical conditions (e.g., nephrotic syndrome)
- Coagulation studies to evaluate for inherited or acquired thrombophilias
- D-dimer assay to support the diagnosis of DVT
Genetic testing may be considered in certain cases to identify inherited thrombophilias

Anticoagulation therapy is the primary treatment for pediatric venous thrombosis:
- Unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) for initial treatment
- Warfarin or other vitamin K antagonists for long-term therapy
Thrombolytic therapy may be considered in certain cases, such as:
- Life-threatening or limb-threatening thrombosis
- Thrombosis with significant morbidity or mortality
Catheter-directed thrombolysis or thrombectomy may be used in select cases
Supportive care, such as pain management and compression stockings, is also important

Ultrasound (US) is the primary imaging modality for diagnosing deep venous thrombosis (DVT) in children
Compression US assesses non-compressibility of the vein to diagnose DVT
Doppler US evaluates blood flow and detects thrombus
Contrast-enhanced US or CT scans are used for central venous thrombosis
Magnetic Resonance Angiography (MRA) or Venography are used for complex or distal thrombosis

Clinical presentation varies depending on age and location of the thrombosis
Signs and symptoms include:
- Pain, swelling, or tenderness in the affected limb
- Palpable cord or mass
- Decreased mobility or activity
- Cyanosis or pallor
Physical exam includes:
- Inspection for swelling, erythema, or discoloration
- Palpation for tenderness or a palpable cord
- Assessment of peripheral pulses

Laboratory tests identify underlying causes or risk factors:
- Complete Blood Count (CBC) for infection or inflammation
- Blood chemistry tests for underlying medical conditions (e.g., nephrotic syndrome)
- Coagulation studies for inherited or acquired thrombophilias
- D-dimer assay supports the diagnosis of DVT
Genetic testing may identify inherited thrombophilias in certain cases

Anticoagulation therapy is the primary treatment for pediatric venous thrombosis:
- Unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) for initial treatment
- Warfarin or other vitamin K antagonists for long-term therapy
Thrombolytic therapy may be used in:
- Life-threatening or limb-threatening thrombosis
- Thrombosis with significant morbidity or mortality
Catheter-directed thrombolysis or thrombectomy may be used in select cases
Supportive care includes pain management and compression stockings

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