# Venous Thromboembolism in Pediatric Musculoskeletal Infections: Diagnostic Challenges in a Resource‐Limited Setting

## TL;DR

This paper discusses the challenges of diagnosing blood clots in children with musculoskeletal infections in areas with limited medical resources.

## Contribution

The study highlights diagnostic approaches for venous thromboembolism in pediatric musculoskeletal infections when advanced imaging is unavailable.

## Key findings

- Two children with musculoskeletal infections developed deep vein thrombosis and pulmonary embolism.
- Bedside Doppler ultrasonography and clinical evaluation can aid diagnosis in the absence of advanced imaging.
- Prompt anticoagulation and treatment reduced morbidity in both cases.

## Abstract

Venous thromboembolism is a recognized but often underdiagnosed complication of pediatric musculoskeletal infections, particularly in low‐resource settings where access to Doppler ultrasonography, magnetic resonance imaging, and computed tomography pulmonary angiography (CTPA) remains limited. We describe two previously healthy children who developed deep vein thrombosis with pulmonary embolism secondary to acute musculoskeletal infection. Both presented initially with fever, severe limb pain, and rapidly progressive swelling, followed by the onset of tachypnoea and respiratory compromise. Doppler ultrasonography confirmed lower‐limb deep vein thrombosis in both cases, while computed tomography pulmonary angiography in one child demonstrated bilateral pulmonary emboli with pulmonary infarction. In the second child, pulmonary embolism was diagnosed based on clinical deterioration and characteristic chest radiographic findings in the absence of available computed tomography. Both children were managed successfully with intravenous antibiotics, therapeutic anticoagulation, and surgical drainage where indicated, although one required mechanical ventilation in the pediatric intensive care unit. These cases highlight the diagnostic challenges of venous thromboembolism complicating musculoskeletal infection in resource‐limited settings and emphasize the importance of maintaining a high index of suspicion when limb swelling worsens or respiratory symptoms develop. Bedside Doppler ultrasonography and timely referral remain essential tools for reducing morbidity when advanced imaging is inaccessible.

In children with musculoskeletal infection, disproportionate limb swelling or new‐onset respiratory compromise should prompt evaluation for venous thromboembolism. Bedside Doppler ultrasonography can support timely diagnosis and guide anticoagulation when advanced imaging is unavailable in resource‐limited settings.

Axial CTPA‐intraluminal filling defect, located centrally within the left lower lobe pulmonary artery (center of crosshair).