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

Christoph Male; Peter Chait; Jeffrey S. Ginsberg; Kim Hanna; Maureen Andrew; Jacqueline Halton; Ron Anderson; Patricia McCusker; John Wu; Thomas Abshire; Irene Cherrick; Donald Mahoney; Lesley Mitchell

doi:10.1055/s-0037-1613054

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2002; 87(04): 593-598
DOI: 10.1055/s-0037-1613054

Review Article

Schattauer GmbH

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

Results of the PARKAA Study

Christoph Male

¹The Hospital for Sick Children, Toronto

,

Peter Chait

¹The Hospital for Sick Children, Toronto

,

Jeffrey S. Ginsberg

²McMaster University, Hamilton

,

Kim Hanna

³Bayer Inc., Toronto

,

Maureen Andrew

¹The Hospital for Sick Children, Toronto

,

Jacqueline Halton

⁴Children’s Hospital of Eastern Ontario, Ottawa

,

Ron Anderson

⁵Alberta Children’s Hospital, Calgary

,

Patricia McCusker

⁶Children’s Hospital of Western Ontario, London

,

John Wu

⁷British Columbia Children’s Hospital, Vancouver, Canada

,

Thomas Abshire

⁸Emory University School of Medicine, Atlanta

,

Irene Cherrick

⁹University Hospital, Syracuse

,

Donald Mahoney

¹⁰Texas Children’s Hospital, Houston, USA

,

Lesley Mitchell

¹The Hospital for Sick Children, Toronto

› Institutsangaben

Abstract

Summary

Deep 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.

Keywords

Deep vein thrombosis - upper body venous system - ultrasound - venography - diagnosis - children

Volltext

Referenzen

References
1 Hull R, Hirsh J, Sackett DL, Taylor DW, Carter C, Turpie AG. et al. Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis. Circulation 1981; 64: 622-5.
2 de Valois JC, van Schaik CC, Verzijlbergen F, van Ramshorst B, Eikelboom BC, Meuwissen OJ. Contrast venography: from gold standard to “golden backup” in clinically suspected deep vein thrombosis. Eur Radiol 1990; 11: 131-7.
3 Lensing AW, Buller HR, Prandoni P, Batchelor D, Molenaar AH, Cogo A. et al. Contrast venography, the gold standard for the diagnosis of deep-vein thrombosis: improvement in observer agreement. Thromb Haemost 1992; 67: 8-12.
4 Lensing AW, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G. et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 1989; 320: 342-5.
5 Mantoni M. Diagnosis of deep venous thrombosis by duplex sonography. Acta Radiol 1989; 30: 575-9.
6 Habscheid W, Hohmann M, Wilhelm T, Epping J. Real-time ultrasound in the diagnosis of acute deep venous thrombosis of the lower extremity. Angiology 1990; 41: 599-608.
7 Schindler JM, Kaiser M, Gerber A, Vuilliomenet A, Popovic A, Bertel O. Colour coded duplex sonography in suspected deep vein thrombosis of the leg. BMJ 1990; 301: 1369-70.
8 Cogo A, Lensing AW, Prandoni P, Buller HR, Girolami A, ten Cate JW. Comparison of real-time B-mode ultrasonography and Doppler ultrasound with contrast venography in the diagnosis of venous thrombosis in symptomatic outpatients. Thromb Haemost 1993; 70: 404-7.
9 Cogo A, Lensing AW, Wells P, Prandoni P, Buller HR. Noninvasive objective tests for the diagnosis of clinically suspected deep-vein thrombosis. Haemostasis 1995; 25: 27-39.
10 Kearon C, Julian JA, Newman TE, Ginsberg JS. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med 1998; 128: 663-77.
11 David M, Andrew M. Venous thromboembolic complications in children. J Pediatr 1993; 123: 337-46.
12 Andrew M, David M, Adams M, Ali K, Anderson R, Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood 1994; 83: 1251-7.
13 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics 1995; 96: 939-43.
14 Nowak-Gottl U, von Kries R, Gobel U. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child Fetal Neonatal Ed 1997; 76: F163-F167.
15 Massicotte MP, Dix D, Monagle P, Adams M, Andrew M. Central venous catheter related thrombosis in children: analysis of the Canadian Registry of Venous Thromboembolic Complications. J Pediatr 1998; 133: 770-6.
16 Monagle P, Adams M, Mahoney M, Ali K, Barnard D, Bernstein M. et al. Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res 2000; 47: 763-6.
17 Prandoni P, Polistena P, Bernardi E, Cogo A, Casara D, Verlato F. et al. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 1997; 157: 57-62.
18 Falk RL, Smith DF. Thrombosis of upper extremity thoracic inlet veins: diagnosis with duplex Doppler sonography. Am J Roentgenol 1987; 149: 677-82.
19 Knudson GJ, Wiedmeyer DA, Erickson SJ, Foley WD, Lawson TL, Mewissen MW. et al. Color Doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis. Am J Roentgenol 1990; 154: 399-403.
20 Baxter GM, Kincaid W, Jeffrey RF, Millar GM, Porteous C, Morley P. Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol 1991; 64: 777-81.
21 Haire WD, Lynch TG, Lieberman RP, Lund GB, Edney JA. Utility of duplex ultrasound in the diagnosis of asymptomatic catheter-induced subclavian vein thrombosis. J Ultrasound Med 1991; 10: 493-6.
22 Koksoy C, Kuzu A, Kutlay J, Erden I, Ozcan H, Ergin K. The diagnostic value of colour Doppler ultrasound in central venous catheter related thrombosis. Clin Radiol 1995; 50: 687-9.
23 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-44.
24 Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J. Deep venous thrombosis: US assessment using vein compression. Radiology 1987; 162: 191-4.
25 Wells PS, Lensing AW, Davidson BL, Prins MH, Hirsh J. Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. A metaanalysis. Ann Intern Med 1995; 122: 47-53.
26 Derish MT, Smith DW, Frankel LR. Venous catheter thrombus formation and pulmonary embolism in children. Pediatr Pulmonol 1995; 20: 349-54.
27 Uderzo C, Faccini P, Rovelli A, Arosio M, Marchi PF, Riva A. et al. Pulmonary thromboembolism in childhood leukemia: 8-years’ experience in a pediatric hematology center. J Clin Oncol 1995; 13: 2805-12.
28 Moore TB, Chow VJ, Ferry D, Feig SA. Intracardiac right-to-left shunting and the risk of stroke during bone marrow infusion. Bone Marrow Transplant 1997; 19: 855-6.
29 Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in peripheral venous and arterial catheters: systematic review and metaanalysis of randomised controlled trials. BMJ 1998; 316: 969-75.
30 Barzaghi A, Dell’Orto M, Rovelli A, Rizzari C, Colombini A, Uderzo C. Central venous catheter clots: incidence, clinical significance and catheter care in patients with hematologic malignancies. Pediatr Hematol Oncol 1995; 12: 243-50.