Тромбоз вен таза и нижних конечностей у детей с остеомиелитом: диагностическая роль КТ-флебографии

Идрисова Р.М., Махачев Б.М. Тромбоз вен таза и нижних конечностей у детей с остеомиелитом: диагностическая роль КТ-флебографии. Consilium Medicum. 2026;28(12):1–5. DOI: 10.26442/20751753.2026.12.203525

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Idrisova RM, Makhachev BM. Pelvic and lower extremity venous thrombosis in children with osteomyelitis: the diagnostic role of CT phlebography. A review. Consilium Medicum. 2025;28(12):1–5. DOI: 10.26442/20751753.2026.12.203525

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Аннотация

Венозный тромбоз является потенциально опасным сосудистым осложнением острого гематогенного остеомиелита у детей, особенно при тяжелом течении заболевания и инфицировании штаммами Staphylococcus aureus. Несмотря на то что венозный тромбоз у детей встречается реже, чем у взрослых, его своевременное выявление имеет ключевое значение для предотвращения жизнеугрожающих последствий, включая тромбоэмболию легочной артерии и септические эмболии. Клиническая диагностика тромбоза у данной категории пациентов существенно затруднена в связи со сходством симптомов с проявлениями основного инфекционного процесса и часто запаздывает, что негативно влияет на прогноз заболевания. «Золотым стандартом» первичного инструментального обследования остается ультразвуковое исследование вен с допплерографией, обладающее высокой доступностью и безопасностью. Однако диагностические возможности ультразвука ограничены при оценке проксимальных отделов венозного русла, включая подвздошные и тазовые вены, а также при выраженном воспалительном процессе и атипичном клиническом течении заболевания. В этих условиях особое значение приобретает компьютерная томография с контрастной венографией (КТ-флебография). КТ-флебография демонстрирует высокую диагностическую эффективность в выявлении тромбов в анатомически труднодоступных зонах, позволяет точно определить протяженность тромботического процесса, его проксимальное распространение и наличие потенциально опасных признаков, таких как флотирующие фрагменты тромба. Дополнительным преимуществом метода является возможность одновременной оценки сосудистых осложнений и инфекционно-воспалительных изменений костей и мягких тканей в рамках одного исследования. КТ-флебография особенно показана при сохраняющейся лихорадке, персистирующей бактериемии, отсутствии ожидаемого клинического улучшения на фоне проводимого лечения, а также при появлении симптомов, подозрительных на тромбоэмболические осложнения. Обоснованное применение КТ с соблюдением принципов радиационной безопасности и индивидуализированным диагностическим подходом способствует повышению точности диагностики и своевременной коррекции лечебной тактики. В обзоре обобщены современные данные о тромбозе вен таза и нижних конечностей у детей с остеомиелитом и подчеркнута ключевая диагностическая роль КТ-флебографии в педиатрической практике.

Ключевые слова: остеомиелит, венозный тромбоз, дети, компьютерная томография с контрастной венографией, тромбоэмболия, диагностика

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Venous thrombosis is a potentially life-threatening vascular complication of acute hematogenous osteomyelitis in children, particularly in cases of severe disease and infection caused by Staphylococcus aureus. Although venous thrombosis occurs less frequently in pediatric patients than in adults, its timely recognition is critical for preventing serious and potentially fatal outcomes, including pulmonary embolism and septic embolic events. Clinical diagnosis of venous thrombosis in children with osteomyelitis is often challenging due to the overlap of symptoms with those of the underlying infectious process, which may lead to delayed detection and adversely affect clinical outcomes. Ultrasound with Doppler imaging remains the first-line diagnostic modality owing to its availability, non-invasiveness, and lack of radiation exposure. However, its diagnostic sensitivity is limited when evaluating proximal venous segments, such as the iliac and pelvic veins, as well as in patients with extensive inflammatory changes or atypical clinical presentations. In such cases, computed tomography with contrast-enhanced venography (CT phlebography) plays an increasingly important role. CT phlebography has demonstrated high diagnostic accuracy in detecting venous thrombi located in anatomically inaccessible regions and allows precise assessment of thrombus extent, proximal propagation, and the presence of high-risk features, including floating thrombus components. An additional advantage of CT imaging is the ability to simultaneously evaluate venous thrombosis and associated infectious and inflammatory complications of osteomyelitis affecting bones and surrounding soft tissues within a single examination. CT phlebography is particularly indicated in patients with persistent fever, ongoing bacteremia, lack of expected clinical improvement despite adequate therapy, or clinical signs suggestive of thromboembolic complications. When applied judiciously and in accordance with radiation safety principles, CT venography enhances diagnostic accuracy and supports timely optimization of therapeutic strategies. This review summarizes current evidence on pelvic and lower-extremity venous thrombosis in children with osteomyelitis and emphasizes the pivotal diagnostic role of CT phlebography in pediatric clinical practice.

Keywords: osteomyelitis, venous thrombosis, children, Staphylococcus aureus, computed tomography with contrast venography, pulmonary embolism, diagnosis

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1. Akhadov TA, Mitish VA, Melnikov IA, et al. Computed and magnetic resonance imaging for osteomyelitis in children. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2021;25(5):303-10 (in Russian). DOI:10.55308/1560-9510-2021-25-5-303-310
2. Gornitzky AL, Kim AE, O'Donnell JM, Swarup I. Diagnosis and Management of Osteomyelitis in Children: A Critical Analysis Review. JBJS Rev. 2020;8(6):e1900202. DOI:10.2106/JBJS.RVW.19.00202
3. Belokrylov NM, Schepalov AV, Antonov DV, et al. On the question of osteomyelitis and its consequences in children: literature review. Perm Medical Journal. 2020;37(3):40-57 (in Russian). DOI:10.17816/pmj37340-57
4. Mashkov AE, Slesarev VV, Polyanskaya ZI. Ileofemoral thrombosis as a complication of acute hematogenous osteomyelitis of the femoral bone in a 3-year-old child. Detskaya khirurgiya (Russian Journal of Pediatric Surgery). 2019;23(3):163-5 (in Russian). DOI:10.18821/1560-9510-2019-23-3-163-165
5. Woods CR, Bradley JS, Chatterjee A, et al. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. J Pediatric Infect Dis Soc. 2021;10(8):801-44. DOI:10.1093/jpids/piab027
6. Restrepo R, Park HJ, Karakas SP, et al. Bacterial osteomyelitis in pediatric patients: a comprehensive review. Skeletal Radiol. 2024;53(10):2195-210. DOI:10.1007/s00256-024-04639-x
7. Liu L, Guo L, Wang Z, et al. Pediatric deep venous thrombosis associated with Staphylococcus aureus osteomyelitis. J Infect Dev Ctries. 2023;17(4):494-9. DOI:10.3855/jidc.17026
8. Ratnayake K, Davis AJ, Brown L, Young TP. Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era. Am J Emerg Med. 2015;33(10):1420-4. DOI:10.1016/j.ajem.2015.07.011
9. Hansen J, Ngatuvai M, Bermudez A, et al. Popliteal deep vein thrombosis in a pediatric patient with Streptococcus viridans osteomyelitis: a case report. J Surg Case Rep. 2024;2024(12):rjae758. DOI:10.1093/jscr/rjae758
10. Wang S, Wang M, Ning B, Zhang W. Clinical characteristics, pathogenesis, treatment and prognosis of osteomyelitis in children: a retrospective study from a single center. World J Emerg Med. 2023;14(4):312-6. DOI:10.5847/wjem.j.1920-8642.2023.069
11. Sheikh HQ, Aqil A, Kirby A, Hossain FS. Panton-Valentine leukocidin osteomyelitis in children: a growing threat. Br J Hosp Med (Lond). 2015;76(1):18-24. DOI:10.12968/hmed.2015.76.1.18
12. He Y, Liu S, Su Y. Risk factors of deep vein thrombosis in children with osteomyelitis. Ann Med. 2023;55(2):2249011. DOI:10.1080/07853890.2023.2249011
13. Cox M, Epelman M, Chandra T, et al. Non-Catheter-related Venous Thromboembolism in Children: Imaging Review from Head to Toe. Radiographics. 2017;37(6):1753-74. DOI:10.1148/rg.2017170036
14. Hollmig ST, Copley LA, Browne RH, et al. Deep venous thrombosis associated with osteomyelitis in children. J Bone Joint Surg Am. 2007;89(7):1517-23. DOI:10.2106/JBJS.F.01102
15. Song S, Li Z, Zhao G, et al. Epidemiology and risk factors for thrombosis in children and newborns: systematic evaluation and meta-analysis. BMC Pediatr. 2023;23(1):292. DOI:10.1186/s12887-023-04122-x
16. Azzam M, AlTalhi YM, Alsawadi H, et al. Incidence of and Risk Factors for Central Venous Catheter Thrombosis: Results from a Single-Center Pediatric Intensive Care Unit. Children (Basel). 2024;11(11):1394. DOI:10.3390/children11111394
17. Citla Sridhar D, Abou-Ismail MY, Ahuja SP. Central venous catheter-related thrombosis in children and adults. Thromb Res. 2020;187:103-12. DOI:10.1016/j.thromres.2020.01.017
18. Ligon JA, Journeycake JM, Josephs SC, et al. Differentiation of Deep Venous Thrombosis Among Children With or Without Osteomyelitis. J Pediatr Orthop. 2018;38(10):e597-603. DOI:10.1097/BPO.0000000000001240
19. Lee CY, Lee YS, Tsao PC, et al. Musculoskeletal Sepsis Associated with Deep Vein Thrombosis in a Child. Pediatr Neonatol. 2016;57(3):244-7. DOI:10.1016/j.pedneo.2013.09.004
20. McNeil JC. Acute Hematogenous Osteomyelitis in Children: Clinical Presentation and Management. Infect Drug Resist. 2020;13:4459-73. DOI:10.2147/IDR.S257517
21. Hanna I, Gonzalez VB, Koul PB. Septic Pulmonary Embolism in Pediatric Population: A Case Series With Literature Review. Pediatr Infect Dis J. 2025;44(6):503-5. DOI:10.1097/INF.0000000000004703
22. Khurtsilava I, Kanjaradze D, Tsirdava N, et al. Concurrent Hematogenous Osteomyelitis, Deep Vein Thrombosis, and Septic Pulmonary Embolism in an Adolescent Male: A Rare Presentation. Cureus. 2025;17(3):e80057. DOI:10.7759/cureus.80057
23. Jia H, Liu T. A short period of anticoagulant treatment for venous thrombosis associated with osteomyelitis is feasible: 6 cases report. Medicine (Baltimore). 2025;104(24):e42930. DOI:10.1097/MD.0000000000042930
24. Eshonova TD. Acute hematogenous osteomyelitis in children. Pediatria n.a. G.N. Speransky. 2016;95(2):146-52 (in Russian).
25. Audu CO, Wakefield TW, Coleman DM. Pediatric deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2019;7(3):452-62. DOI:10.1016/j.jvsv.2018.12.012
26. Landisch R, Braun KA, Punzalan R. Screening Ultrasound for Early Detection of Venous Thromboembolism in Critically Ill Injured Children. Journal of the American College of Surgeons. 2016; 223(4):S90. DOI:10.1016/j.jamcollsurg.2016.06.179
27. Hosokawa T, Tanami Y, Sato Y, et al. Role of ultrasound in the treatment of pediatric infectious diseases: case series and narrative review. World J Pediatr. 2023;19(1):20-34. DOI:10.1007/s12519-022-00606-5
28. Radulescu VC. Management of venous thrombosis in the pediatric patient. Pediatric Health Med Ther. 2015;6:111-9. DOI:10.2147/PHMT.S65697
29. Betensky M, Goldenberg NA. Post-thrombotic syndrome in children. Thromb Res. 2018;164:129-35. DOI:10.1016/j.thromres.2017.07.024
30. Frush DP, Sorantin E. Radiation use in diagnostic imaging in children: approaching the value of the pediatric radiology community. Pediatr Radiol. 2021;51(4):532-43. DOI:10.1007/s00247-020-04924-6
31. Lee CY, Lee YS, Tsao PC, et al. Musculoskeletal sepsis associated with deep vein thrombosis in a child. Pediatr Neonatol. 2013;57(3):244-7. DOI:10.1016/J.PEDNEO.2013.09.004
32. Shajdakov EV, Sannikov AB, Emelyanenko VM, et al. MRI and CT-venography in the diagnosis of hemodynamic disturbances in patients with chronic lower extremities venous disorders. Part III. Possibilities of CT-investigation in diagnosing of venous hemodynamics violations. Medical Visualization. 2021;25(4):53-74 (in Russian). DOI:10.24835/1607-0763-902
33. Goel D, Smitthimedhin A, Yadav B, et al. Ultrasound-detected venous changes associated with peripheral intravenous placement in children. Br J Nurs. 2020;29(8):S44-9. DOI:10.12968/bjon.2020.29.8.S44

Авторы

Р.М. Идрисова*^1,2, Б.М. Махачев^1,2

¹ФГБОУ ВО «Дагестанский государственный медицинский университет» Минздрава России, Махачкала, Российская Федерация
²ГБУ РД «Детская республиканская клиническая больница им. Н.М. Кураева», Махачкала, Российская Федерация
*Rayka-9999@mail.ru

________________________________________________

Rakhmat M. Idrisova*^1,2, Bashir M. Makhachev^1,2
¹Dagestan State Medical University, Makhachkala, Russian Federation
²Kuraev Children's Republican Clinical Hospital, Makhachkala, Russian Federation
*Rayka-9999@mail.ru

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