title: Thrombosis of Inferior Vena Cava Diagnosed Using Point-of-Care Ultrasound After Pediatric Near-Syncope.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is extremely rare but under recognized in the pediatric population. Although the literature on the use of ultrasound to detect VTEs in adults is plentiful, little has been documented on its use in the pediatric population.
  
  
  METHODS
  We present a case of a healthy 16-year-old female who presented to our emergency department with 3 months of dyspnea on exertion and one episode of near-syncope. Point-of-care cardiac ultrasound identified an inferior vena cava thrombosis. Subsequent computed tomography angiography diagnosed concurrent bilateral pulmonary emboli (PE). The patient's identical twin sister presented with similar symptoms shortly thereafter and was also diagnosed with VTE and bilateral PE. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates an instance of VTE and pulmonary embolism in twin adolescent girls. Physical examination findings, electrocardiogram, chest x-ray study, and several previous evaluations did not reveal the diagnosis. Point of care ultrasound was used to correctly diagnosis VTE and for heightened concern for a pulmonary embolism.
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Shadi
authors.initials: S
authors.lastname: Lahham
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Lester
authors.initials: L
authors.lastname: Tsai
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Samer
authors.initials: S
authors.lastname: Assaf
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Roman
authors.initials: R
authors.lastname: Navarro
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Faried
authors.initials: F
authors.lastname: Banimahd
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Subeh
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Erik D
authors.initials: ED
authors.lastname: Barton
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: Abigail
authors.initials: A
authors.lastname: Barbera
authors.affiliation: Department of Emergency Medicine, University of California, Irvine, California.
authors.forename: J Christian
authors.initials: JC
authors.lastname: Fox
mesh_terms: D000293:Adolescent; D003276:Contraceptives, Oral / Q000009:adverse effects; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D019095:Point-of-Care Systems; D013575:Syncope / Q000209:etiology; D014430:Twins, Monozygotic; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D054556:Venous Thromboembolism / Q000139:chemically induced / Q000000981:diagnostic imaging*
chemical_list: D003276:Contraceptives, Oral
keywords: pediatric ultrasound; pulmonary embolism; venous thromboembolism