Diagnosis of Venous Thromboembolism in Children

Christoph Male; Stefan Kuhle; Lesley Mitchell

doi:10.1055/s-2003-42588

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2003; 29(4): 377-390
DOI: 10.1055/s-2003-42588

Diagnosis of Venous Thromboembolism in Children

Christoph Male¹ , Stefan Kuhle^2,3 , Lesley Mitchell³

¹Children's Hospital University of Vienna Vienna, Austria
²Research Fellow, University of Toronto, Toronto, Ontario, Canada
³Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Abstract

ABSTRACT

Venous thromboembolic events (VTE) in children are mostly related to central venous lines (CVL), and are located in the central upper venous system. The incidence of VTE in children with CVL is significant. However, the majority of CVL-related VTE do not present with typical symptoms or are not recognized due to underlying disease. Asymptomatic VTE still cause significant venous obstruction and are associated with short-term and long-term clinical complications. Because the clinical diagnosis of CVL-related VTE is unreliable, screening by objective radiographic testing is required. In the upper venous system, ultrasound is insensitive for the VTE in the central venous system and venography is not sensitive for jugular VTE. Therefore, a combination of ultrasound and venography is required for accurate diagnosis of CVL-related VTE in the upper venous system. Whether ultrasound alone is accurate for CVL-related VTE in the lower venous system is uncertain. Magnetic resonance venography will likely prove a valid alternative for diagnosis of VTE both in the upper and lower central venous system, and may be combined with magnetic resonance pulmonary angiography to screen for pulmonary embolism.

KEYWORDS

Diagnosis - venous thrombosis - children - central venous lines - sensitivity

Full Text

References

REFERENCES

1 David M, Andrew M. Venous thromboembolic complications in children. J Pediatr . 1993; 123 337-346
2 Andrew M, David M, Adams M. et al . Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood . 1994; 83 1251-1257
3 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics . 1995; 96 939-943
4 Nowak-Göttl U, von Kries R, Göbel U. Neonatal symptomatic thromboembolism in Germany: two year survey. Arch Dis Child Fetal Neonatal Ed . 1997; 76 F163-F167
5 van Ommen H C, Heijboer H, Büller H R, Hirasing R A, Heijmans H S, Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr . 2001; 139 676-681
6 Adams M, Chan A, Massicotte M P, deVeber G, Andrew M. 1-800-NO-CLOTS: A quaternary care solution to a new tertiary care disease: childhood thrombophilia (Abst). Thromb Haemost . 2001; 86(Suppl) OC2462
7 Monagle P, Adams M, Mahoney M. et al . Outcome of pediatric thromboembolic disease: a report from the Canadian Childhood Thrombophilia Registry. Pediatr Res . 2000; 47 763-766
8 Carter C, Gent M. The epidemiology of venous thrombosis. In: Colman R, Hirsh J, Marder V, Salzman E, eds. Hemostasis and Thrombosis Basic Principles and Clinical Practice; 3rd ed Philadelphia, PA: JB Lippincott 1982: 805-819
9 Weinmann E E, Salzman E W. Deep-vein thrombosis. N Engl J Med . 1994; 331 1630-1641
10 Prandoni P, Bernardi E. Upper extremity deep vein thrombosis. Curr Opin Pulm Med . 1999; 5 222-226
11 Lensing A WA, Hirsh J, Büller H R. Diagnosis of venous thrombosis. In: Colman RW, Hirsh J, Marder VJ, Salzman EW, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice; 2nd ed Philadelphia, PA: JB Lippincott 1994: 1297-1321
12 Barnes R W, Wu K K, Hoak J C. Fallibility of the clinical diagnosis of venous thrombosis. JAMA . 1975; 234 605-607
13 O'Donnell Jr F T, Abbott W M, Athanasoulis C A, Millan V G, Callow A D. Diagnosis of deep venous thrombosis in the outpatient by venography. Surg Gynecol Obstet . 1980; 150 69-74
14 Haeger K. Problems of acute deep venous thrombosis. I. The interpretation of signs and symptoms. Angiology . 1969; 20 219-223
15 Molloy W, English J, O'Dwyer R, O'Connell J. Clinical findings in the diagnosis of proximal deep vein thrombosis. Ir Med J . 1982; 75 119-120
16 Massicotte P, Julian J A, Gent M. et al . An open-label randomized controlled trial of low molecular weight heparin for the prevention of central venous line-related thrombotic complications in children: the PROTEKT trial. Thromb Res . 2003; 109 101-108
17 Glaser D W, Medeiros D, Rollins N, Buchanan G R. Catheter-related thrombosis in children with cancer. J Pediatr . 2001; 138 255-259
18 Male C, Chait P, Andrew M, Hanna K, Julian J, Mitchell L. Central venous line-related thrombosis in children: association with central venous line location and insertion technique (in press). Blood.
19 Haire W D, Lieberman R P, Lund G B, Edney J A, Kessinger A, Armitage J O. Thrombotic complications of silicone rubber catheters during autologous marrow and peripheral stem cell transplantation: prospective comparison of Hickman and Groshong catheters. Bone Marrow Transplant . 1991; 7 57-59
20 Horne III K M, May D J, Alexander H R. et al . Venographic surveillance of tunneled venous access devices in adult oncology patients. Ann Surg Oncol . 1995; 2 174-178
21 De Cicco M, Matovic M, Balestreri L. et al . Central venous thrombosis: an early and frequent complication in cancer patients bearing long-term silastic catheter. A prospective study. Thromb Res . 1997; 86 101-113
22 Durbec O, Viviand X, Potie F, Vialet R, Albanese J, Martin C. A prospective evaluation of the use of femoral venous catheters in critically ill adults. Crit Care Med . 1997; 25 1986-1989
23 Wells P S, Hirsh J, Anderson D R. et al . Accuracy of clinical assessment of deep-vein thrombosis. Lancet . 1995; 345 1326-1330
24 Wells P S, Anderson D R, Bormanis J. et al . Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet . 1997; 350 1795-1798
25 Lee A Y, Ginsberg J S. The role of D-dimer in the diagnosis of venous thromboembolism. Curr Opin Pulm Med . 1997; 3 275-279
26 Crippa L, D'Angelo S V, Tomassini L, Rizzi B, D'Alessandro G, D'Angelo A. The utility and cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis. Haematologica . 1997; 82 446-451
27 Perrier A, Desmarais S, Miron M J. et al . Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet . 1999; 353 190-195
28 Hull R, Hirsh J, Sackett D L. et al . Clinical validity of a negative venogram in patients with clinically suspected venous thrombosis. Circulation . 1981; 64 622-625
29 de Valois C J, van Schaik C C, Verzijlbergen F, van Ramshorst B, Eikelboom B C, Meuwissen O J. Contrast venography: from gold standard to “golden backup” in clinically suspected deep vein thrombosis. Eur J Radiol . 1990; 11 131-137
30 Lensing A W, Büller H R, Prandoni P. et al . Contrast venography, the gold standard for the diagnosis of deep-vein thrombosis: improvement in observer agreement. Thromb Haemost . 1992; 67 8-12
31 Prandoni P, Polistena P, Bernardi E. et al . Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med . 1997; 157 57-62
32 Rabinov K, Paulin S. Roentgen diagnosis of venous thrombosis in the leg. Arch Surg . 1972; 104 134-144
33 Thomas M L, Fletcher E W. The techniques of pelvic phlebography. Clin Radiol . 1967; 18 399-402
34 Baxter G M, Kincaid W, Jeffrey R F, Millar G M, Porteous C, Morley P. Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol . 1991; 64 777-781
35 Andrew M. Developmental hemostasis: relevance to thromboembolic complications in pediatric patients. Thromb Haemost . 1995; 74 415-425
36 Bettmann M A, Robbins A, Braun S D, Wetzner S, Dunnick N R, Finkelstein J. Contrast venography of the leg: diagnostic efficacy, tolerance, and complication rates with ionic and nonionic contrast media. Radiology . 1987; 165 113-116
37 Katayama H, Yamaguchi K, Kozuka T, Takashima T, Seez P, Matsuura K. Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. Radiology . 1990; 175 621-628
38 Aburahma A F, Powell M, Robinson P A. Prospective study of safety of lower extremity phlebography with nonionic contrast medium. Am J Surg . 1996; 171 255-260
39 Wall B F, Hart D. Revised radiation doses for typical X-ray examinations. Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB, National Radiological Protection Board. Br J Radiol . 1997; 70 437-439
40 Kalebo P, Ekman S, Lindbratt S. et al . Percentage of inadequate phlebograms and observer agreement in thromboprophylactic multicenter trials using standardized methodology and central assessment. Thromb Haemost . 1996; 76 893-896
41 Kalodiki E, Nicolaides A N, Al Kutoubi A, Cunningham D A, Mandalia S. How “gold” is the standard?. <~>Interobservers' variations on venograms. Int Angiol . 1998; 17 83-88
42 Lensing A W, Prandoni P, Brandjes D. et al . Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med . 1989; 320 342-345
43 Mantoni M. Diagnosis of deep venous thrombosis by duplex sonography. Acta Radiol . 1989; 30 575-579
44 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
45 Schindler J M, Kaiser M, Gerber A, Vuilliomenet A, Popovic A, Bertel O. Colour coded duplex sonography in suspected deep vein thrombosis of the leg. Br Med J . 1990; 301 1369-1370
46 Cogo A, Lensing A W, Prandoni P, Büller H R, Girolami A, ten Cate W J. 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; 70 404-407
47 Cogo A, Lensing A W, Wells P, Prandoni P, Büller H R. Noninvasive objective tests for the diagnosis of clinically suspected deep-vein thrombosis. Haemostasis . 1995; 25 27-39
48 Kearon C, Julian J A, Newman T E, Ginsberg J S. Noninvasive diagnosis of deep venous thrombosis. McMaster Diagnostic Imaging Practice Guidelines Initiative. Ann Intern Med . 1998; 128 663-677
49 Wells P S, Lensing A W, Davidson B L, Prins M H, Hirsh J. Accuracy of ultrasound for the diagnosis of deep venous thrombosis in asymptomatic patients after orthopedic surgery. A meta-analysis. Ann Intern Med . 1995; 122 47-53
50 Fraser J D, Anderson D R. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology . 1999; 211 9-24
51 Baldt M M, Zontsich T, Stumpflen A. et al . Deep venous thrombosis of the lower extremity: efficacy of spiral CT venography compared with conventional venography in diagnosis. Radiology . 1996; 200 423-428
52 Loud P A, Katz D S, Klippenstein D L, Shah R D, Grossman Z D. Combined CT venography and pulmonary angiography in suspected thromboembolic disease: diagnostic accuracy for deep venous evaluation. AJR Am J Roentgenol . 2000; 174 61-65
53 Cham M D, Yankelevitz D F, Shaham D. et al . Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group. Radiology . 2000; 216 744-751
54 Garg K, Kemp J L, Wojcik D. et al . Thromboembolic disease: comparison of combined CT pulmonary angiography and venography with bilateral leg sonography in 70 patients. AJR Am J Roentgenol . 2000; 175 997-1001
55 Ghaye B, Szapiro D, Willems V, Dondelinger R F. Combined CT venography of the lower limbs and spiral CT angiography of pulmonary arteries in acute pulmonary embolism: preliminary results of a prospective study. JBR-BTR . 2000; 83 271-278
56 Evans A J, Sostman H D, Knelson M H. et al . 1992 ARRS Executive Council Award. Detection of deep venous thrombosis: prospective comparison of MR imaging with contrast venography. AJR Am J Roentgenol . 1993; 161 131-139
57 Carpenter J P, Holland G A, Baum R A, Owen R S, Carpenter J T, Cope C. Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography. J Vasc Surg . 1993; 18 734-741
58 Dupas B, el Kouri D, Curtet C. et al . Angiomagnetic resonance imaging of iliofemorocaval venous thrombosis. Lancet . 1995; 346 17-19
59 Laissy J P, Cinqualbre A, Loshkajian A. et al . Assessment of deep venous thrombosis in the lower limbs and pelvis: MR venography versus duplex Doppler sonography. AJR Am J Roentgenol . 1996; 167 971-975
60 Ruehm S G, Wiesner W, Debatin J F. Pelvic and lower extremity veins: contrast-enhanced three-dimensional MR venography with a dedicated vascular coil-initial experience. Radiology . 2000; 215 421-427
61 Fraser D G, Moody A R, Davidson I R, Martel A L, Morgan P S. Deep venous thrombosis: diagnosis by using venous enhanced subtracted peak arterial MR venography versus conventional venography. Radiology . 2003; 226 812-820
62 Stern J B, Abehsera M, Grenet D. et al . Detection of pelvic vein thrombosis by magnetic resonance angiography in patients with acute pulmonary embolism and normal lower limb compression ultrasonography. Chest . 2002; 122 115-121
63 Mitchell L G, Andrew M, Hanna K. et al . A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L-asparaginase: results of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia Treated with Asparaginase (PARKAA) Study. Cancer . 2003; 97 508-516
64 Mitchell L, Hanna K, Andrew M, for the PAARKA investigators. Trend to efficacy of prophylaxis with antithrombin concentrates in children with acute lymphoblastic leukemia treated with L-asparaginase: results of the PARKAA study (Abst). Haemostasis . 2000; 30 107
65 Male C, Chait P, Ginsberg J. et al . Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body in children: results of the PARKAA study. Thromb Haemost . 2002; 87 593-599
66 Chait P, Dinyari M, Massicotte M P. The sensitivity and specificity of lineograms and ultrasound compared to venography for the diagnosis of central venous line-related thrombosis in symptomatic children: the LUV study (Abst). Thromb Haemost . 2001; 86(Suppl) P697
67 Knudson G J, Wiedmeyer D A, Erickson S J. et al . Color Doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis. AJR Am J Roentgenol . 1990; 154 399-403
68 Haire W D, Lynch T G, Lund G B, Lieberman R P, Edney J A. Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis. J Vasc Surg . 1991; 13 391-397
69 Baarslag H J, van Beek J E, Koopman M M, Reekers J A. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med . 2002; 136 865-872
70 Gooding G A, Hightower D R, Moore E H, Dillon W P, Lipton M J. Obstruction of the superior vena cava or subclavian veins: sonographic diagnosis. Radiology . 1986; 159 663-665
71 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; 50 687-689
72 Patel M C, Berman L H, Moss H A, McPherson S J. Subclavian and internal jugular veins at Doppler US: abnormal cardiac pulsatility and respiratory phasicity as a predictor of complete central occlusion. Radiology . 1999; 211 579-583
73 Marsh D, Wilkerson S A, Cook L N, Pietsch J B. Right atrial thrombus formation screening using two-dimensional echocardiograms in neonates with central venous catheters. Pediatrics . 1988; 81 284-286
74 Moukarzel A, Azancot-Benisty A, Brun P, Vitoux C, Cezard J P, Navarro J. M-mode and two-dimensional echocardiography in the routine follow-up of central venous catheters in children receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr . 1991; 15 551-555
75 Mehta S, Connors Jr F A, Danish E H, Grisoni E. Incidence of thrombosis during central venous catheterization of newborns: a prospective study. J Pediatr Surg . 1992; 27 18-22
76 Dollery C M, Sullivan I D, Bauraind O, Bull C, Milla P J. Thrombosis and embolism in long-term central venous access for parenteral nutrition. Lancet . 1994; 344 1043-1045
77 Korones D N, Buzzard C J, Asselin B L, Harris J P. Right atrial thrombi in children with cancer and indwelling catheters. J Pediatr . 1996; 128 841-846
78 Gilon D, Schechter D, Rein A J. et al . Right atrial thrombi are related to indwelling central venous catheter position: insights into time course and possible mechanism of formation. Am Heart J . 1998; 135 457-462
79 Balling G, Vogt M, Kaemmerer H, Eicken A, Meisner H, Hess J. Intracardiac thrombus formation after the Fontan operation. J Thorac Cardiovasc Surg . 2000; 119 745-752
80 Godwin J D, Webb W R. Contrast-related flow phenomena mimicking pathology on thoracic computed tomography. J Comput Assist Tomogr . 1982; 6 460-464
81 Engel I A, Auh Y H, Rubenstein W A, Sniderman K, Whalen J P, Kazam E. CT diagnosis of mediastinal and thoracic inlet venous obstruction. AJR Am J Roentgenol . 1983; 141 521-526
82 Moncada R, Cardella R, Demos T C. et al . Evaluation of superior vena cava syndrome by axial CT and CT phlebography. AJR Am J Roentgenol . 1984; 143 731-736
83 Raptopoulos V. Computed tomography of the superior vena cava. Crit Rev Diagn Imaging . 1986; 25 373-429
84 Albertyn L E, Alcock M K. Diagnosis of internal jugular vein thrombosis. Radiology . 1987; 162 505-508
85 Gorich J, Flentje M, Guckel F, Beyer-Enke S A, van Kaick G. Computed tomographic imaging of collateral pathways in stenoses of the large mediastinal veins [in German]. Rofo Fortschr Geb Röntgenstr Nuklearmed . 1988; 148 560-565
86 Wilimas J A, Hudson M, Rao B, Luo X, Lott L, Kaste S C. Late vascular occlusion of central lines in pediatric malignancies (Abst). Pediatrics . 1998; 101 e7
87 Qanadli S D, El Hajjam M, Bruckert F. et al . Helical CT phlebography of the superior vena cava: diagnosis and evaluation of venous obstruction. AJR Am J Roentgenol . 1999; 172 1327-1333
88 International Commision on Radiological Protection. 1990 Recommendations of the International Commission on Radiological Protection. Ann ICRP . 1991; 21 1-201
89 Hansen M E, Spritzer C E, Sostman H D. Assessing the patency of mediastinal and thoracic inlet veins: value of MR imaging. AJR Am J Roentgenol . 1990; 155 1177-1182
90 Haire W D, Lynch T G, Lieberman R P, Lund G B, Edney J A. Utility of duplex ultrasound in the diagnosis of asymptomatic catheter-induced subclavian vein thrombosis. J Ultrasound Med . 1991; 10 493-496
91 Finn J P, Zisk J H, Edelman R R. et al . Central venous occlusion: MR angiography. Radiology . 1993; 187 245-251
92 Hartnell G G, Hughes L A, Finn J P, Longmaid 3rd E H. Magnetic resonance angiography of the central chest veins. A new gold standard?. Chest . 1995; 107 1053-1057
93 Rose S C, Gomes A S, Yoon H C. MR angiography for mapping potential central venous access sites in patients with advanced venous occlusive disease. AJR Am J Roentgenol . 1996; 166 1181-1187
94 Lebowitz J A, Rofsky N M, Krinsky G A, Weinreb J C. Gadolinium-enhanced body MR venography with subtraction technique. AJR Am J Roentgenol . 1997; 169 755-758
95 Shinde T S, Lee V S, Rofsky N M, Krinsky G A, Weinreb J C. Three-dimensional gadolinium-enhanced MR venographic evaluation of patency of central veins in the thorax: initial experience. Radiology . 1999; 213 555-560
96 Rodenwaldt J, Kopka L, Castillo E, Fischer U, Grabbe E. The MR imaging of the vena cava system: a comparison of different technics [in German]. Rofo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahren . 1999; 171 100-105
97 Thornton M J, Ryan R, Varghese J C, Farrell M A, Lucey B, Lee M J. A three-dimensional gadolinium-enhanced MR venography technique for imaging central veins. AJR Am J Roentgenol . 1999; 173 999-1003
98 Kroencke T J, Taupitz M, Arnold R, Fritsche L, Hamm B. Three-dimensional gadolinium-enhanced magnetic resonance venography in suspected thrombo-occlusive disease of the central chest veins. Chest . 2001; 120 1570-1576
99 Pippus K G, Giacomantonio J M, Gillis D A, Rees E P. Thrombotic complications of saphenous central venous lines. J Pediatr Surg . 1994; 29 1218-1219
100 Shefler A, Gillis J, Lam A, O'Connell A J, Schell D, Lammi A. Inferior vena cava thrombosis as a complication of femoral vein catheterisation. Arch Dis Child . 1995; 72 343-345
101 Talbott G A, Winters W D, Bratton S L, O'Rourke P P. A prospective study of femoral catheter-related thrombosis in children. Arch Pediatr Adolesc Med . 1995; 149 288-291
102 Krafte-Jacobs B, Williams J, Soldin S J. Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Pediatr . 1995; 126 50-54
103 Pierce C M, Wade A, Mok Q. Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med . 2000; 26 967-972
104 Nolewajka A J, Goddard M D, Brown T C. Temporary transvenous pacing and femoral vein thrombosis. Circulation . 1980; 62 646-650
105 Meredith J W, Young J S, O'Neil E A, Snow D C, Hansen K J. Femoral catheters and deep venous thrombosis: a prospective evaluation with venous duplex sonography. J Trauma . 1993; 35 187-190
106 Trottier S J, Veremakis C, O'Brien J, Auer A I. Femoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial. Crit Care Med . 1995; 23 52-59
107 Joynt G M, Kew J, Gomersall C D, Leung V Y, Liu E K. Deep venous thrombosis caused by femoral venous catheters in critically ill adult patients. Chest . 2000; 117 178-183
108 Merrer J, De Jonghe B, Golliot F. et al . Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA . 2001; 286 700-707
109 Massicotte M P, 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; 133 770-776
110 Kazmers A, Groehn H, Meeker C. Duplex examination of the inferior vena cava. Am Surg . 2000; 66 986-989
111 Miga D E, McKellar L F, Denslow S, Wiles H B, Case C L, Gillette P C. Incidence of femoral vein occlusion after catheter ablation in children: evaluation with magnetic resonance angiography. Pediatr Cardiol . 1997; 18 204-207
112 Kim J H, Lee Y S, Kim S H, Lee S K, Lim M K, Kim H S. Does umbilical vein catheterization lead to portal venous thrombosis?. <~>Prospective US evaluation in 100 neonates. Radiology . 2001; 219 645-650
113 Roy M, Turner-Gomes S, Gill G, Way C, Mernagh J, Schmidt B. Accuracy of Doppler echocardiography for the diagnosis of thrombosis associated with umbilical venous catheters. J Pediatr . 2002; 140 131-134
114 Alvarez F, Bernard O, Brunelle F, Hadchouel P, Odievre M, Alagille D. Portal obstruction in children. I. Clinical investigation and hemorrhage risk. J Pediatr . 1983; 103 696-702
115 Tessler F N, Gehring B J, Gomes A S. et al . Diagnosis of portal vein thrombosis: value of color Doppler imaging. AJR Am J Roentgenol . 1991; 157 293-296
116 Lee W B, Wong K P. CT demonstration of thrombosis of the portal venous system. Australas Radiol . 1988; 32 360-364
117 Levy H M, Newhouse J H. MR imaging of portal vein thrombosis. AJR Am J Roentgenol . 1988; 151 283-286
118 Yadav S, Dutta A K, Sarin S K. Do umbilical vein catheterization and sepsis lead to portal vein thrombosis?. <~>A prospective, clinical, and sonographic evaluation. J Pediatr Gastroenterol Nutr . 1993; 17 392-396
119 Schwartz D S, Gettner P A, Konstantino M M. et al . Umbilical venous catheterization and the risk of portal vein thrombosis. J Pediatr . 1997; 131 760-762
120 Guimaraes H, Castelo L, Guimaraes J. et al . Does umbilical vein catheterization to exchange transfusion lead to portal vein thrombosis?. Eur J Pediatr . 1998; 157 461-463
121 Nemmers D W, Thorpe P E, Knibbe M A, Beard D W. Upper extremity venous thrombosis. Case report and literature review. Orthop Rev . 1990; 19 164-172
122 Elliot G. Upper-extremity deep vein thrombosis. Lancet . 1997; 349 1188-1189
123 Andrew M, Brooker L A. Hemostatic complications in renal disorders of the young. Pediatr Nephrol . 1996; 10 88-99
124 Cremin B J, Davey H, Oleszczuk-Raszke K. Neonatal renal venous thrombosis: sequential ultrasonic appearances. Clin Radiol . 1991; 44 52-55
125 Wright N B, Blanch G, Walkinshaw S, Pilling D W. Antenatal and neonatal renal vein thrombosis: new ultrasonic features with high frequency transducers. Pediatr Radiol . 1996; 26 686-689
126 Hibbert J, Howlett D C, Greenwood K L, MacDonald L M, Saunders A J. The ultrasound appearances of neonatal renal vein thrombosis. Br J Radiol . 1997; 70 1191-1194
127 Said R, Hamzeh Y. Digital subtraction venography in the diagnosis of renal vein thrombosis. Am J Nephrol . 1991; 11 305-308
128 Kawashima A, Sandler C M, Ernst R D, Tamm E P, Goldman S M, Fishman E K. CT evaluation of renovascular disease. Radiographics . 2000; 20 1321-1340
129 Hricak H, Amparo E, Fisher M R, Crooks L, Higgins C B. Abdominal venous system: assessment using MR. Radiology . 1985; 156 415-422
130 Tempany C M, Morton R A, Marshall F F. MRI of the renal veins: assessment of nonneoplastic venous thrombosis. J Comput Assist Tomogr . 1992; 16 929-934
131 Kanagasundaram N S, Bandyopadhyay D, Brownjohn A M, Meaney J F. The diagnosis of renal vein thrombosis by magnetic resonance angiography. Nephrol Dial Transplant . 1998; 13 200-202
132 Monagle P, Peters M, Andrew M. Pulmonary embolism in childhood. In: van Beek E, Oudkerk M, ten Cate JW, eds. Pulmonary Embolism: Epidemiology, Diagnosis, and Treatment Oxford, England: Blackwell Scientific 2000
133 Buck J R, Connors R H, Coon W W, Weintraub W H, Wesley J R, Coran A G. Pulmonary embolism in children. J Pediatr Surg . 1981; 16 385-391
134 Derish M T, Smith D W, Frankel L R. Venous catheter thrombus formation and pulmonary embolism in children. Pediatr Pulmonol . 1995; 20 349-354
135 The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). JAMA . 1990; 263 2753-2759
136 Perrier A, Bounameaux H, Morabia A. et al . Diagnosis of pulmonary embolism by a decision analysis-based strategy including clinical probability, D-dimer levels, and ultrasonography: a management study. Arch Intern Med . 1996; 156 531-536
137 Wells P S, Ginsberg J S, Anderson D R. et al . Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med . 1998; 129 997-1005
138 Kearon C, Hirsh J. The diagnosis of pulmonary embolism. Haemostasis . 1995; 25 72-87
139 Anderson D R, Wells P S. Improvements in the diagnostic approach for patients with suspected deep vein thrombosis or pulmonary embolism. Thromb Haemost . 1999; 82 878-886
140 Hull R D, Hirsh J, Carter C J. et al . Pulmonary angiography, ventilation lung scanning, and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan. Ann Intern Med . 1983; 98 891-899
141 Papanicolaou N, Treves S. Pulmonary scintigraphy in pediatrics. Semin Nucl Med . 1980; 10 259-285
142 van Rossum B A, Pattynama P M, Ton E R. et al . Pulmonary embolism: validation of spiral CT angiography in 149 patients. Radiology . 1996; 201 467-470
143 Remy-Jardin M, Remy J, Artaud D, Deschildre F, Duhamel A. Peripheral pulmonary arteries: optimization of the spiral CT acquisition protocol. Radiology . 1997; 204 157-163
144 Drucker E A, Rivitz S M, Shepard J A. et al . Acute pulmonary embolism: assessment of helical CT for diagnosis. Radiology . 1998; 209 235-241
145 ACCP Consensus Committee on Pulmonary Embolism. American College of Chest Physicians. Opinions regarding the diagnosis and management of venous thromboembolic disease. Chest . 1998; 113 499-504
146 Mayo J R, Remy-Jardin M, Muller N L. et al . Pulmonary embolism: prospective comparison of spiral CT with ventilation-perfusion scintigraphy. Radiology . 1997; 205 447-452
147 Musset D, Parent F, Meyer G. et al . Diagnostic strategy for patients with suspected pulmonary embolism: a prospective multicentre outcome study. Lancet . 2002; 360 1914-1920
148 Loubeyre P, Revel D, Douek P. et al . Dynamic contrast-enhanced MR angiography of pulmonary embolism: comparison with pulmonary angiography. AJR Am J Roentgenol . 1994; 162 1035-1039
149 Leung D A, McKinnon G C, Davis C P, Pfammatter T, Krestin G P, Debatin J F. Breath-hold, contrast-enhanced, three-dimensional MR angiography. Radiology . 1996; 200 569-571
150 Meaney J F, Weg J G, Chenevert T L, Stafford-Johnson D, Hamilton B H, Prince M R. Diagnosis of pulmonary embolism with magnetic resonance angiography. N Engl J Med . 1997; 336 1422-1427
151 Gupta A, Frazer C K, Ferguson J M. et al . Acute pulmonary embolism: diagnosis with MR angiography. Radiology . 1999; 210 353-359
152 Hoffmann U, Schima W, Herold C. Pulmonary magnetic resonance angiography. Eur Radiol . 1999; 9 1745-1754
153 Rand T, Kohlhauser C, Popow C. et al . Sonographic detection of internal jugular vein thrombosis after central venous catheterization in the newborn period. Pediatr Radiol . 1994; 24 577-580
154 Hausler M, Hubner D, Delhaas T, Muhler E G. Long-term complications of inferior vena cava thrombosis. Arch Dis Child . 2001; 85 228-233