article · Pediatric Blood & Cancer
Vascular malformations cause a range of clinical issues, such as pain, bleeding, physical impairment, and blood clots. A study evaluating thirty young patients with low-flow vascular malformations examined the connection between reported pain, laboratory clot markers, and imaging results. Most participants, twenty-five out of thirty, experienced pain, split between acute and chronic episodes. Every patient found to have internal blood clots or calcified vein stones through Doppler ultrasound or magnetic resonance imaging suffered from pain. Furthermore, patients experiencing acute pain demonstrated significantly higher levels of D-dimer, a biomarker for clot breakdown, compared to those with chronic pain or no pain at all. These findings link acute pain episodes directly to active clotting and thrombosis within low-flow vascular lesions containing a venous component.
Children with vascular malformations frequently suffer from unexplained pain that affects their daily lives. By connecting acute pain episodes to elevated D-dimer levels and localised blood clots visible on ultrasound scans, clinicians obtain clearer diagnostic clues. This helps healthcare teams quickly identify active clotting complications rather than attributing discomfort to generalised inflammation, allowing for more targeted and timely pain management.
This clinical research provides diagnostic evidence rather than a product, representing early-stage insights for hospital care protocols. It could inform diagnostic pathways or clinical decision-support tools used by paediatricians and radiologists to evaluate acute pain via routine D-dimer testing and ultrasound. However, the abstract does not indicate an immediate commercial application pathway or formal product development.
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BACKGROUND: Patients with vascular malformations (VMs) experience a wide spectrum of symptoms including pain, physical impairment, bleeding, thrombosis and psychosocial problems. The occurrence of pain in these patients might be caused by thrombosis or phleboliths (due to venous stasis), ischemia, or neuropathy. We aimed to assess the frequency of pain in patients with low-flow VM and to study its association with laboratory markers and radiological evidence of thrombosis. PATIENTS AND METHODS: A cross-sectional study that included 30 patients (12 female and 18 male) with low-flow VM. Medical records were reviewed for demographic data and details of VM. Assessment of pain was done by using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and by the Wong-Baker FACES pain rating scale for patients 3 years or older. Markers of thrombosis including D-dimer level were measured. Results of radiologic investigations including Doppler ultrasonography and magnetic resonance imaging (MRI) were collected. RESULTS: The median age of patients was 51.4 months. Of 30 patients, 16 had VMs, 6 patients had lymphatic malformations and 8 had combined malformations. Eleven patients had thrombi or phlebolith by Doppler ultrasound or MRI. Pain was reported by 25 (83%) patients (acute pain in 11 and chronic pain in 14). D-dimer levels were highest in patients with acute pain (median level 1337 ng/mL) compared to those with chronic or no pain (p = 0.002). All 11 patients who had thrombi or phlebolith by Doppler ultrasound or MRI reported pain (6 with acute and 5 with chronic pain). CONCLUSION: Acute pain in patients with low-flow VMs with venous component is associated with high D-dimer and intralesional thrombosis by Doppler ultrasound.
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DOI: 10.1002/1545-5017.70481
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