Pediatric emergency department point-of-care ultrasound diagnosis of unprovoked iliofemoral deep vein thrombosis in an adolescent: A case report

Pediatric deep vein thrombosis is uncommon and often presents with nonspecific symptoms that may be mistaken for musculoskeletal conditions. Early diagnosis can be particularly challenging in the pediatric emergency department, as commonly used adult diagnostic tools have limited applicability in children. This case is noteworthy because the thrombosis was unprovoked, occurred in an otherwise healthy adolescent, and was rapidly identified using point-of-care ultrasound, which facilitated timely escalation and coordinated multidisciplinary care. We report the case of a 15-year-old male who presented with progressive pain and swelling of the right lower limb. Initial clinical assessment suggested a musculoskeletal injury. However, point-of-care ultrasound performed in the pediatric emergency department demonstrated loss of venous compressibility and intraluminal echogenic material within the common femoral vein. Subsequent formal duplex ultrasonography confirmed an occlusive thrombus extending from the common femoral vein into the iliac vein. This case emphasizes the diagnostic difficulties posed by deep vein thrombosis in children. It also demonstrates how point-of-care ultrasound, when used at the bedside in the pediatric emergency department, can enable early recognition of proximal thrombosis even when validated adult decision tools are unavailable.