Umbilical venous catheterization gone wrong: Hepatic complications

Abstract

Hepatic complications of malposition of umbilical venous catheter (UVC) are uncommon and occur due to extravasation of hypertonic fluids and the blood products in the liver tissue. Various hepatic complications include thrombosis of hepatic vessels, hepatic necrosis, hepatic fluid collections, and hematoma, with the intraparenchymal liver lesions seen along the course of ductus venosus. Radiologists must be aware of these complications and their imaging findings, as the timely recognition and immediate management can prevent the fatal outcome. Here, we present a rare case of intraparenchymal liver lesions associated with malposition of UVC in a preterm baby.

Keywords: Extravasation; hepatic necrosis; total parenteral nutrition; umbilical venous catheterization.

Figure 1 (A and B)

(A and B) USG abdomen shows multiple heteroechoic predominantly hyperechoic lesions in superior segment (black arrow) and predominantly hypoechoic in inferior segment of left lobe and posterior segments of right lobe with large exophytic component (white arrow)

Figure 2 (A and B)

(A and B) CECT abdomen at the level of portal vein bifurcation showing multiple mixed density intraparenchymal hepatic lesions, Lesions show mixed areas of hemorrhage and fat density at the periphery (white arrow in A). Note is made of oedema around left portal vein and its branches (small black arrow in A). Similar large heterodense lesion with exophytic component is seen in segment IVB and posterior segments of right lobe shows fluid collection with areas of hemorrhage (white arrow in B)

Figure 3 (A and B)

(A) Chest and abdominal Radiograph showing the abnormal position of UVC with tip (black arrow) at D10-D11 level likely in hepatic parenchyma (white arrow). The gas medial to the catheter outlines the umbilical venous recess. Note is made of umbilical artery catheter with tip lying in midline at the level of D10 vertebra (small black arrow). Note is made of reticulonodular shadowing in bilateral lung. (B) Zoomed image shows the air in the branches of left portalvein (black arrow) and hepatic parenchyma (white arrow)

Figure 4 (A-D)

Follow up USG and CECT after 3 weeks show marked regression in the size of the lesions. The lesions in left lobe in superior segment (arrow in A) are more echogenic. Large exophytic lesion with areas of hemorrhage (arrow in B) also shows significant reduction in the size and is more hypoechoic consistent with resolving hematoma. Peripheral foci of calcification was also seen (small arrow in B). Similar changes were appreciated on CT images with decrease in the size and the hematoma is resolving and appear hypodense (C and D)