title: Venous Malformation and Localized Intravascular Coagulopathy in Children.
abstract: AimLocalized intravascular coagulopathy (LIC) has been described in adults with venous malformation (VM) but rarely reported in children. This study aims to determine the prevalence of LIC in children with VM and associated risk factors.MethodsPatients younger than 18 years with VM from 2010 to 2014 were reviewed. Diagnosis was confirmed by Doppler ultrasound and/or magnetic resonance imaging. Demographics data and VM characteristics including volume, site, extension, painful symptoms, and palpable phleboliths were studied. Plasma D-dimer level of greater than 500 ng/mL was considered as abnormal.ResultsTotal 24 children were included, of whom 8 were boys. Median age of presentation was 9 months (range: 0-12 years). Head-and-neck VM occurred in 17 (70.8%) patients and 3 (12.5%) had multifocal lesions. Seven (29.2%) patients had VM volume greater than 10 mL. Five (20.8%) patients had painful symptoms. Palpable phleboliths were found in two patients. Plasma D-dimer was raised in eight cases (33.3%). One patient with Klippel-Trenaunay syndrome (KTS) had D-dimer level of 5,000 ng/mL. Raised D-dimer was found in 23.5% of small VM (volume < 10 mL) and 57.1% of large VM (p= 0.167). D-dimer was significantly raised in multifocal VM (p= 0.028) and showed increasing trend in lesions with palpable phleboliths (p= 0.101). All patients had sclerotherapy performed with indications (cosmesis 41.7%, enlarging lesion 29.2%, pain 20.8%, bleeding 8.3%). Perioperatively, bolus intravenous fluid and mannitol were given to selected patients. All patients had VM volume reduction after sclerotherapy. There were no major thromboembolic complications.ConclusionLIC with raised D-dimer level occurred in one-third of pediatric VM. It was more common in large, multifocal VM and in those with palpable phleboliths or KTS.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Judy W S
authors.initials: JW
authors.lastname: Hung
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Michael W Y
authors.initials: MW
authors.lastname: Leung
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Clarence S W
authors.initials: CS
authors.lastname: Liu
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, Hong Kong.
authors.forename: Dickson H S
authors.initials: DH
authors.lastname: Fung
authors.affiliation: Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong, Hong Kong.
authors.forename: W L
authors.initials: WL
authors.lastname: Poon
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Felix S D
authors.initials: FS
authors.lastname: Yam
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Yvonne C L
authors.initials: YC
authors.lastname: Leung
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Kenneth Lap Yan
authors.initials: KL
authors.lastname: Chung
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Paula M Y
authors.initials: PM
authors.lastname: Tang
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Nicholas S Y
authors.initials: NS
authors.lastname: Chao
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Queen Elizabeth and United Christian Hospital, Hong Kong, Hong Kong.
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: Liu
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D012307:Risk Factors; D015911:Sclerotherapy; D018608:Ultrasonography, Doppler; D054079:Vascular Malformations / Q000175:diagnosis* / Q000628:therapy; D014680:Veins / Q000002:abnormalities*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D