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Table 2 Definition of symptomatic TE and preferred diagnostic evaluation

From: Evaluation for inherited and acquired prothrombotic defects predisposing to symptomatic thromboembolism in children with acute lymphoblastic leukemia: a protocol for a prospective, observational, cohort study

  Site Likely clinical signs and symptoms Diagnostic method/s
CNS Arterial ischemic stroke +/− hemorrhage Unexplained headaches, vomiting, visual problems, or neurological deficits, seizure, drowsiness or any change in mental status MRI/MRA
Angiogram
Sinovenous thrombosis (SVT) MRI /MRV
CT venogram
PE Pulmonary vasculature Respiratory problems (shortness of breath, tachypnea, dyspnea) hypoxia, chest pain, syncope “Unexplained pneumonia” V/Q scan
Spiral CT
Pulmonary angiogram
DVT Upper venous system Swelling, pain, tenderness, erythema, dilated vessels Bilateral venogram is “gold standard” for diagnosis especially for subclavian/brachial vessels
aDoppler USG sufficient for jugular vein
MRV
Recommend ECHO to evaluate RA
Lower venous system aDoppler USG to evaluate all sites
Venogram is still the gold standard
Cardiac Right atrial (RA) CVL malfunction, sepsis, congestive heart failure ECHO
CVL related Asymptomatic CVL tip thrombi ONLY if the catheter tip is in RA - ECHO
Linogram
Venogram
Only symptomatic CVL TE will be considered significant Swelling, pain, tenderness, erythema, dilated vessels, CVL malfunction requiring revision or renewal, headache, swelling of face Linogram +/− venogram &/or aDoppler USG depending upon the site of thrombosis
  1. In the presence of TE at one site recommend evaluating other sites (especially if anatomically related e.g. jugular vessels in presence of SVT) for associated asymptomatic TE, if possible
  2. TE thromboembolism, CNS central nervous system, MRI Magnetic resonance imaging, MRV Magnetic resonance venogram, MRA Magnetic resonance arteriogram, PE pulmonary embolism, V/Q scan ventilation/perfusion scan CT computerized tomogram, DVT deep venous thrombosis, USG ultrasonogram, CVL central venous line
  3. aDetection of echogenic material within the lumen of a vein on a gray scale and presence of partial or complete absence of flow by pulse wave or color Doppler ultrasonography