Thrombosis in pediatric patient with osteosarcoma

Abstract

A 12-year-old male patient, with a 2-month history of pain in the right hip and claudication, with collateral abdominal circulation and lower right limb edema on physical examination, with pelvic radiographs showing a right iliac crest mass; ultrasound of abdomen and lower right limb (with Doppler) with right iliac crest mass associated with total occlusive thrombus of right common iliac vein, to inferior vena cava at its right atrial outlet; also chest tomography with multiple collateral circulation vessels with extensive thrombus in the inferior vena cava, extending to the right atrium, crossing the tricuspid valve and insinuating itself in the right ventricle, with multiple bilateral pulmonary nodules that, because of their characteristics are highly suggestive of metastatic lesions, and pelvic tomography which shows extensive infiltrating lesion of the right iliac bone, which compromises the entire bone to the height of the acetabular roof; in addition, a mass of soft tissue is documented that displaces adjacent muscles, vascular structures and viscera of the pelvis to the left, with blastic pattern, with lithic areas that compromise the right lateral aspect of S3 and S4, being also infiltrated by the neoplasia. Due to the bone destruction pattern and the morphological aspect of the thrombus, thrombectomy is advised against and tumor biopsy is performed with osteosarcoma report and chemotherapy is initiated.