Cox Mougnyan, Epelman Monica, Chandra Tushar, Meyers Arthur B, Johnson Craig M, Podberesky Daniel J
From the Department of Medical Imaging, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, Del (M.C.); Department of Radiology, Thomas Jefferson University, Philadelphia, Pa (M.C.); and Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, University of Central Florida, 13535 Nemours Pkwy, Orlando, FL 32827 (M.E., T.C., A.B.M., C.M.J., D.J.P.).
Radiographics. 2017 Oct;37(6):1753-1774. doi: 10.1148/rg.2017170036.
Non-catheter-related venous thromboembolism (VTE) is less common in children than in adults. Although the presence of a central venous catheter is the most common cause of venous thrombosis in children, infection and inflammation, malignancy, hypercoagulability, dehydration, and certain sites of normal variant and pathologic anatomic narrowing all predispose to VTE in children. The mortality and morbidity of VTE vary according to the underlying cause, including whether malignancy is present. Various modalities including ultrasonography (US), computed tomography, and magnetic resonance imaging can be used to image VTE, with some modalities better suited to particular parts of the body and clinical scenarios than others. When feasible, US is the initial test of choice for the diagnosis of VTE. US findings of acute VTE include a dilated noncompressible vein, intraluminal echoes, lack of color flow, and abnormal spectral venous waveforms. Serial US examinations are useful for monitoring patient response to therapy; a normal compressible vein will be seen after complete resolution of thrombus, and chronic venous changes including wall thickening, intraluminal webs, and phleboliths, which are readily apparent at US. Accurate and timely diagnosis of VTE must take into account the various advantages and disadvantages of each modality including speed, accuracy, availability, exposure to ionizing radiation, and need for sedation, as well as the clinical stability and transportability of the child. This article reviews some of the more common causes of VTE in children (other than those related to a central venous catheter) according to body part and discusses the associated imaging findings. RSNA, 2017.
非导管相关静脉血栓栓塞（VTE）在儿童中比在成人中少见。尽管中心静脉导管的存在是儿童静脉血栓形成的最常见原因，但感染与炎症、恶性肿瘤、高凝状态、脱水以及某些正常变异和病理性解剖狭窄部位均易导致儿童发生VTE。VTE的死亡率和发病率因潜在病因而异，包括是否存在恶性肿瘤。包括超声检查（US）、计算机断层扫描和磁共振成像在内的各种检查方法可用于对VTE进行成像，其中某些检查方法比其他方法更适合身体的特定部位和临床情况。在可行的情况下，US是诊断VTE的首选初始检查。急性VTE的US表现包括静脉扩张且不可压缩、腔内回声、无血流信号以及异常的静脉频谱波形。系列US检查有助于监测患者对治疗的反应；血栓完全溶解后可见可压缩的正常静脉，以及慢性静脉改变，包括管壁增厚、腔内条索和静脉石，这些在US检查中很容易观察到。VTE的准确及时诊断必须考虑到每种检查方法的各种优缺点，包括速度、准确性、可及性、电离辐射暴露以及镇静需求，以及儿童的临床稳定性和可转运性。本文根据身体部位综述了儿童VTE的一些较常见病因（除与中心静脉导管相关的病因外），并讨论了相关的影像学表现。RSNA，2017年。
