Comparison of Venography and Ultrasound for the Diagnosis of Asymptomatic Deep Vein Thrombosis in the Upper Body in Children

Abstract

SummaryDeep vein thrombosis (DVT) in children occurs primarily in the upper body venous system. This prospective diagnostic study compared bilateral venography and ultrasound for detection of DVT in the upper venous system in 66 children with acute lymphoblastic leukemia. Results were interpreted by central blinded adjudication.Deep venous thrombosis occurred in 29% (19/66) patients. While 15/19 DVT were detected by venography (sensitivity 79%), only 7/19 were detected by ultrasound (sensitivity 37%). The 12 DVT detected by venography but not by ultrasound were located in the subclavian vein or more central veins. Three of 4 DVT detected by ultrasound but not by venography were in the jugular vein. We conclude that ultrasound is insensitive for DVT in the central upper venous system but may be more sensitive than venography in the jugular veins. A combination of both venography and ultrasound is required for screening for DVT in the upper venous system.

Central venous line–related thrombosis in children: association with central venous line location and insertion technique

“…Venography is not sensitive for the detection of VTE in the jugular veins, and ultrasound is not sensitive for VTE in the subclavian veins. 23,24 The present study, which demonstrates a significantly increased incidence of VTE with subclavian (44%) compared with jugular (20%) CVL, provides the most objective information because venography and ultrasound were both used to screen for VTE.…”

“…12,14,22 Recent evidence also shows that ultrasound is insensitive for VTE in the subclavian vein and that venography is insensitive for VTE in the jugular vein. 23,24 Hence, when screening for VTE in the 2 locations, both venography and ultrasound are required.…”

The incidence of venous thromboembolism in thrombophilic children: a prospective cohort study

“…In recent years, thromboembolic events have been increasingly recognized as a major cause of morbidity and mortality in tertiary care pediatrics, especially in newborns and children with neoplastic diseases, in those requiring the placement of central venous lines or the administration of asparaginase or other chemotherapeutic drugs, and in those with congenital heart disease. 3,[15][16][17] In addition, recent case-control studies suggest that thrombophilic children have a higher risk of stroke and other thromboembolic complications than matched control subjects without thrombophilia. [18][19][20][21] We had neither the opportunity of following individuals with cancer nor of observing children receiving central venous lines.…”

Central venous catheter‐related thrombosis and thromboprophylaxis in children: a systematic review and meta‐analysis: comment

“…Whilst symptomatic and asymptomatic CVC-related DVT can have serious sequalae, including post-thrombotic syndrome (PTS), stroke and pulmonary hypertension (PH) [3][4][5], the true rates of short or long-term adverse events following CVC-related DVT in children remain unknown [6,7]. In addition, anticoagulation therapy confers a significant risk of bleeding (up to 56%) and exposes children to traumatic venous blood monitoring [8,9].In addition to the paucity of data regarding the natural history of CVC-related DVT, questions have been raised as to the role of ultrasound screening in assisting in early detection [10,11]. Early detection of CVC-related VTE facilitates timely anticoagulation therapy and may prevent both progression and embolization of the VTE.…”

“…In addition to the paucity of data regarding the natural history of CVC-related DVT, questions have been raised as to the role of ultrasound screening in assisting in early detection [10,11]. Early detection of CVC-related VTE facilitates timely anticoagulation therapy and may prevent both progression and embolization of the VTE.…”