Download PDF
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
1   The Hospital for Sick Children, Toronto
,
Peter Chait
1   The Hospital for Sick Children, Toronto
,
Jeffrey S. Ginsberg
2   McMaster University, Hamilton
,
Kim Hanna
3   Bayer Inc., Toronto
,
Maureen Andrew
1   The Hospital for Sick Children, Toronto
,
Jacqueline Halton
4   Children’s Hospital of Eastern Ontario, Ottawa
,
Ron Anderson
5   Alberta Children’s Hospital, Calgary
,
Patricia McCusker
6   Children’s Hospital of Western Ontario, London
,
John Wu
7   British Columbia Children’s Hospital, Vancouver, Canada
,
Thomas Abshire
8   Emory University School of Medicine, Atlanta
,
Irene Cherrick
9   University Hospital, Syracuse
,
Donald Mahoney
10   Texas Children’s Hospital, Houston, USA
,
Lesley Mitchell
1   The Hospital for Sick Children, Toronto
› Author Affiliations
Further Information

Publication History

Received 08 July 2001

Accepted after resubmission 14 December 2001

Publication Date:
08 December 2017 (online)

Also available at
    Permissions and Reprints

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
 

  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    PubMedSearch in Google Scholar
  • 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.
    Thieme ConnectPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 5 Mantoni M. Diagnosis of deep venous thrombosis by duplex sonography. Acta Radiol 1989; 30: 575-9.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    Thieme ConnectPubMedSearch in Google Scholar
  • 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.
    PubMedSearch in Google Scholar
  • 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.
    PubMedSearch in Google Scholar
  • 11 David M, Andrew M. Venous thromboembolic complications in children. J Pediatr 1993; 123: 337-46.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    PubMedSearch in Google Scholar
  • 13 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics 1995; 96: 939-43.
    PubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    PubMedSearch in Google Scholar
  • 18 Falk RL, Smith DF. Thrombosis of upper extremity thoracic inlet veins: diagnosis with duplex Doppler sonography. Am J Roentgenol 1987; 149: 677-82.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 23 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 134-44.
    CrossrefPubMedSearch in Google Scholar
  • 24 Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J. Deep venous thrombosis: US assessment using vein compression. Radiology 1987; 162: 191-4.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 26 Derish MT, Smith DW, Frankel LR. Venous catheter thrombus formation and pulmonary embolism in children. Pediatr Pulmonol 1995; 20: 349-54.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar
  • 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.
    CrossrefPubMedSearch in Google Scholar