"Initially, my husband and I attributed it to growing pains or a pulled muscle, so we were not overly concerned at first,” recalled Izzy’s mother, Melissa. “Then, one day, Izzy texted me from school, saying she was in pain and it felt like she was walking on a broken leg. I immediately picked her up and took her home."
When the pain wouldn’t go away, Melissa took Izzy to see her pediatrician, who examined her left leg and noticed it was swollen, red and firm to the touch. Suspecting a blood clot, the pediatrician immediately referred Izzy to the pediatric emergency room at Memorial Hermann Katy Hospital.
Upon arrival, the affiliated pediatric emergency team performed an ultrasound on Izzy’s left leg, that revealed a deep vein thrombosis (DVT) or blood clot extending the entire length of her leg. DVTs can be dangerous because if the clot breaks loose, it can travel through the bloodstream and lodge in the lungs, causing a pulmonary embolism, which is a life-threatening condition. Out of caution, they took a CT scan of her lungs.
“I was completely dumbfounded and nervous,” said Melissa. “My initial thoughts were, ‘Does my child have this syndrome where she is prone to developing blood clots? I remember everything happening so quickly. I was a wreck trying to stay composed for Izzy’s sake. Once we told her what was going on and reassured her that she’d be fine, she was less anxious. She was excited about the helicopter ride.”
On the same day, Izzy was airlifted via Memorial Hermann Life Flight® to Children’s Memorial Hermann Hospital in the Texas Medical Center and admitted to the pediatric intensive care unit (PICU), where she was given heparin, a blood thinner, to dissolve the clot.
Uncovering the Cause: An Unusual Discovery Behind the Clot
Additional scans were ordered. Shortly thereafter, doctors discovered an ovarian cyst on her right side, about the size of a basketball and weighing between 10 to 15 pounds.
Matthew Harting, MD, a pediatric surgeon affiliated with Children’s Memorial Hermann, explained that the ovarian cyst had grown slowly which is why there were no significant signs earlier. The cyst caused the blood clot in Izzy’s leg by exerting pressure and obstructing blood flow to her inferior vena cava, a large vein that carries deoxygenated blood from the lower extremities back to the heart.
“When a blood vessel is compressed or obstructed, blood flow may become sluggish – known as stasis, promoting the formation of blood clots,” explained Dr. Harting. “The external pressure (in this case, a large ovarian cyst) can compress blood vessels, leading to a slowdown or obstruction of blood flow, which increases the propensity for thrombus or blood clot formation. Therefore, any ovarian mass or cyst should be thoroughly evaluated, and a treatment plan formulated immediately.”
"Izzy had a compromised pulse in her foot," added Melissa. "That's why she needed immediate care. Without improving blood flow promptly, the situation could have gotten worse, quickly leading to tissue damage.”
Dr. Harting successfully removed the ovarian cyst laparoscopically, using a minimally invasive technique involving small incisions and specialized instruments with visualization by a small camera. This approach helps to reduce scarring and postoperative pain while shortening recovery time compared to traditional open surgery.
A few days later, Ibraheem Malkawi, MD, a pediatric interventional radiologist affiliated with Children’s Memorial Hermann Hospital, performed a thrombectomy to remove the clot in her left leg. For this minimally invasive procedure, the surgeon uses imaging guidance to precisely remove blood clots, minimizing risks such as infection and allowing for faster recovery.
Traditionally, patients had been treated with oral anticoagulation only, which is effective in preventing further clot formation but less effective in removing extensive clots involving multiple segments.
Advances in imaging and interventional radiology procedures now allow for complete clot removal, which restores venous blood flow immediately. This approach not only reduces the risk of long-term chronic clot formation but also provides both short-term and long-term relief from symptoms such as swelling and pain.
Izzy reported a noticeable decrease in left thigh pain and heaviness the evening after the procedure.
“Dr. Malkawi was wonderful and explained everything so thoroughly to the point where we didn’t have any remaining questions,” said Melissa. “We felt comfortable moving forward with her procedure.”
Interventional Radiology: Minimally Invasive Treatment for Blood Clots
Interventional radiology leverages cutting-edge imaging technologies like ultrasound (US), fluoroscopy (low dose X-ray), computed tomography (CT), X-ray, and magnetic resonance imaging (MRI) to conduct minimally invasive procedures. These techniques employ small instruments such as needles, wires and catheters, guided by precise imaging, to address various medical conditions in specific areas in the body, including blood vessels.
“Thanks to advancements in technology, many diseases that once required open surgery can now be addressed with minimal risk, reduced discomfort and quicker recovery times,” explained Dr. Malkawi. “The use of imaging eliminates the need for large incisions to visualize the target area. Instead, we can make tiny incisions to guide precise instruments into the body for treatment. This approach leads to shorter procedure times, reduced pain, fewer complications and faster recovery times for patients.”
In December 2023, Dr. Malkawi performed a minimally invasive thrombectomy on Izzy to remove the blood clot. He made a small incision in the back of her leg to access the blood vessel. A thin tube called a catheter was guided to the blood clot using X-ray imaging. In IR procedures like this, dye is often used to see the clot more clearly. The clot is then removed using special tools or suction through the catheter.
Following her procedure, Izzy stayed in the hospital for a few more days to monitor and address any potential complications from the procedure. "Dr. Malkawi told my husband and me the procedure went well," said Melissa, explaining that he had removed about eight inches of blood clot from Izzy's leg.
Izzy's symptoms improved significantly the same evening as the IR procedure, and she continued blood thinners post-surgery. Although she had some initial pain where the ovarian cyst was removed, she was otherwise doing well.
Izzy Today: Pain-Free and Making Progress After Surgery
Izzy is doing well six months after her procedure. You’d never know what she went through—she has no pain in her leg. She continues her follow up with the hematology and surgery teams at Children’s Memorial Hermann Hospital. Also, at her last appointment, Dr. Malkawi performed a venography and another ultrasound of her leg, and everything was normal.
Melissa expressed her gratitude, saying, “Throughout this journey, the support from the medical teams at Children’s Memorial Hermann has been outstanding. They helped us navigate this challenging time, helping Izzy regain her normal self again. Our daughter’s journey reminds us of the importance of listening to our children’s symptoms and seeking medical attention when something feels off.”
Learn more information about the interventional radiology program »