Premature newborn now 1 month old with decreased urine output who had an umbilical arterial catheter placed at birth

US of thrombus in aorta caused by umbilical arterial catheter
Coronal grayscale US of the aorta centered at the level of the kidneys (above) shows a round echogenic object within the aorta at the level of the origin of the renal arteries. Coronal color doppler US of the aorta (below) shows good blood flow around the object and into the renal arteries which was confirmed on spectral doppler US.

The diagnosis was non-occlusive thrombus of the aorta secondary to past umbilical arterial catheterization.

Premature newborn after placement of two umbilical arterial catheters

AXR of umbilical arterial catheter malposition
Supine and cross-table lateral AXR shows the tip of one umbilical arterial catheter to be at T6 and the tip of the other umbilical arterial catheter to be at L1. Note on these images how after insertion at the umbilicus the umbilical arterial catheters first head caudad in the umbilical artery and internal iliac artery before heading cephalad in the common iliac artery and aorta. There is faint ground-glass opacity in the lungs.

The diagnosis was normal position (at T6) and low malposition (at L1) of the umbilical arterial catheters in a patient with respiratory distress syndrome.

Premature newborn after placement of two umbilical arterial catheters

AXR of umbilical arterial catheter malposition
Supine AXR shows the tip of one umbilical arterial catheter to be at T5 and the tip of the other umbilical arterial catheter to be at T12. Note on this AP image how after insertion at the umbilicus the umbilical arterial catheters first head caudad in the umbilical artery and internal iliac artery before heading cephalad in the common iliac artery and aorta.

The diagnosis was high malposition (at T5) and low malposition (at T12) of the umbilical arterial catheters.

Newborn with hypoxic ischemic encephalopathy status post umbilical arterial and umbilical venous catheter placement

AXR of umbilical arterial catheter in the celiac artery
CXR AP shows the tip of the umbilical arterial catheter to be in the celiac artery. The tip of the umbilical venous catheter is at the junction of the inferior vena cava and right atrium. Esophageal temperature probe tip projects over the mid-esophagus. The patient is lying upon a cooling blanket.

The diagnosis was low malposition of the umbilical arterial catheter and correct position of the umbilical venous catheter in a patient with hypoxic ischemic encephalopathy.

Premature newborn after umbilical arterial and umbilical venous catheter placement

CXR of umbilical arterial catheter in left subclavian artery
CXR AP shows the tip of the umbilical arterial catheter to be in the left subclavian artery. The tip of the umbilical venous catheter is deep within the right atrium. The lungs show minimal ground-glass opacity.

The diagnosis was high malposition of the umbilical arterial catheter and high malposition of the umbilical venous catheter in a patient with respiratory distress syndrome.

Premature newborn after umbilical arterial and umbilical venous catheter placement

CXR of umbilical arterial catheter malposition
CXR AP shows the tip of the umbilical arterial catheter to be at T3 near the aortic arch. The tip of the umbilical venous catheter is in the right portal vein. The lungs show diffuse ground-glass opacity.

The diagnosis was high malposition of the umbilical arterial catheter and intrahepatic malposition of the umbilical venous catheter in a patient with respiratory distress syndrome.

Newborn after umbilical arterial and umbilical venous catheter placement

AXR of normal position of an umbilical arterial catheter
AXR AP and cross-table lateral shows normal course of the umbilical arterial catheter from umbilical artery to internal iliac artery to common illiac artery to aorta (in and caudad and then cephalad on the AP view) while coursing anterior to the spine on the lateral view with the catheter tip appropriately positioned at T7. The umbilical venous catheter has a normal course from umbilical vein to left portal vein to ductus venosus to left hepatic vein to inferior vena cava (in and cephalad on the AP view) while coursing through the liver on the lateral view with the catheter tip positioned in the right atrium

The diagnosis was appropriate position of the umbilical arterial catheter and high malposition of the umbilical venous catheter.

Newborn with hypoxic ischemic encephalopathy

CXR of esophageal temperature probe
CXR AP shows a nasogastric tube coursing within the esophagus into the stomach while the twisted wire probe next to it with its tip in the mid-esophagus represents an esophageal temperature probe in appropriate position. The patient is lying upon a cooling blanket while being cooled to treat their hypoxic ischemic encephalopathy.

The diagnosis was a patient with hypoxic ischemic encephalopathy with a mimic of a nasogastric tube.

Preschooler on ECMO after cardiac surgery with a tube in the esophagus

CXR of transesophageal echocardiogram probe
CXR AP shows an open chest with an ECMO arterial catheter tip in the aortic arch and an ECMO venous catheter tip in the right atrium. A wide-diameter tube with a sensor at the end projects over the esophagus which represents a transesophageal echocardiogram probe.

The diagnosis was a patient on extracorporeal membrane oxygenation with a mimic of a nasogastric tube.

Premature newborn after nasogastric tube placement

AXR of gastric perforation from nasogastric tube placement
Supine and left lateral decubitus AXR (left) show a nasogastric tube with its tip deep in the pelvis without evidence of free air. Supine AXR taken after pulling the nasogastric tube back into the stomach (above right) shows increased lucency throughout the central abdomen and left lateral decubitus AXR taken at same time (below right) shows air between the abdominal wall and the liver.

The diagnosis was pneumoperitoneum due to gastric perforation during nasogastric tube placement which became visible only after the nasogastric tube was pulled out of the hole it had made in the stomach wall.

Newborn with distended abdomen after nasogastric tube placement

AXR of gastric perforation from nasogastric tube placement
Supine AXR (left) shows a large amount of air within the abdomen and air outlining both sides of bowel wall (Rigler’s sign) in the right lower quadrant. Supine AXR taken later after pulling back of the nasogastric tube out of the stomach shows visualization of the falciform ligament over the spine (American football sign)

The diagnosis was pneumoperitoneum due to gastric perforation during nasogastric tube placement.

Premature newborn with abdominal distension after nasogastric tube placement

AXR of esophageal perforation from nasogastric tube placement
Supine AXR (above) shows increased lucency in the upper abdomen. The cross-table lateral AXR (below) shows air between the anterior abdominal wall and the bowel. The nasogastric tube follows a very straight course and does not curve towards the stomach. Note on both views that the tip of the nasogastric tube does not project over the stomach. US performed subsequently showed the tip of the nasogastric tube was in the retroperitoneum and not in the stomach.

The diagnosis was perforation of the esophagus during nasogastric tube placement. In the operating room the pneumoperitoneum was found to be due to an ileal perforation.