Author: Pediatric Imaging

Premature newborn after PICC placement

CXR of peripherally inserted central catheter / PICC changing in position as arms move up and down
CXR AP with the left arm down (left) shows the tip of the left upper extremity PICC to project deep within the right atrium. CXR AP with the left arm up (right) obtained later the same day shows the tip of the PICC to have moved back into the superior vena cava. There is ground glass opacity throughout the lungs.

The diagnosis was change in position of the upper extremity PICC tip due to change in arm position in a patient with respiratory distress syndrome.

Infant status post PICC placement 1 month ago with an incidental calcification on their AXR

CXR and US of inferior vena cava thrombus caused by peripherally inserted central catheter / PICC
AXR AP shows the tip of a lower extremity PICC projecting within the inferior vena cava with its tip at T11 with a long tubular calcification extending from the PICC tip to the level of the right atrium. Transverse US of the liver at the level of the hepatic veins draining into the inferior vena cava shows a round echogenic lesion with posterior shadowing within the inferior vena cava that extended from the tip of the PICC to the cavo-atrial junction.

The diagnosis was chronic thrombus of the inferior vena cava secondary to PICC placement.

Infant with fever who had a PICC placed two months ago

CT of inferior vena cava thrombus caused by peripherally inserted central catheter / PICC
AXR AP obtained after PICC placement shows a left lower extremity PICC tip projecting near the bifurcation of the iliac veins. Axial CT with contrast of the abdomen obtained two months later shows a thin filling defect throughout the entire inferior vena cava which extended to the left iliac vein, seen as a round high density lesion in the medial aspect of the proximal inferior vena cava (above right) and as a round low density lesion centrally in the distal inferior vena cava (below right).

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The diagnosis was chronic thrombus of the inferior vena cava and left iliac vein secondary to PICC placement.

Premature newborn after PICC placement

AXR of peripherally inserted central catheter / PICC in the spinal canal
AXR AP shows a left lower extremity PICC that does not follow the course of the iliac vein and whose tip projects at the level of L3 and that projects within the spinal canal on the lateral radiograph. The only gas within the abdomen is in the stomach while all of the small bowel is in a silo outside the abdomen.

The diagnosis was malposition of the PICC within the spinal canal in a patient with gastroschisis.

Premature newborn after placement of two umbilical venous catheters

AXR of umbilical venous catheter misplacement in the inferior mesenteric vein
AXR AP shows the tip of the first umbilical venous catheter coursing inferiorly deep into the inferior mesenteric vein and the tip of the second umbilical venous catheter projecting over the umbilical vein. The tip of the umbilical arterial catheter projects at T6.

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

Premature newborn after umbilical venous catheter placement

AXR of umbilical venous catheter misplacement in umbilical vein
AXR AP shows the tip of the umbilical venous catheter curling back upon itself within the umbilical vein. The tip of the umbilical arterial catheter projects at T6. The proximal small bowel is massively dilated.

The diagnosis was low malposition of the umbilical venous catheter and appropriate position of the umbilical arterial catheter in a patient with jejunal atresia.

Premature newborn after umbilical venous catheter placement now with increasing C reactive protein after receiving total parenteral nutrition through the catheter

AXR and CT of extravasation of TPN into the liver due to umbilical venous catheter perforation out of the vein
AXR AP shows the tip of the umbilical venous catheter to project over the left portal vein. Axial CT with contrast of the abdomen shows multiple low density lesions which appear to be joined together in the left lobe of the liver.

The diagnosis was perforation of the umbilical venous catheter out of the left portal vein with subsequent infusion of total parenteral nutrition into the liver parenchyma forming an intrahepatic fluid collection which became infected.

Premature newborn after umbilical venous catheter placement

AXR of umbilical venous catheter perforation out of vein
Supine AXR (upper left) shows the umbilical venous catheter tip coursing to the left of midline. Cross-table lateral AXR (upper right) shows the umbilical venous catheter tip projecting over the anterior abdomen with air bubbles along the catheter tract. CXR taken after placement of a second umbilical venous catheter (below) shows the new umbilical venous catheter tip in the right or left atrium and the first umbilical venous catheter tip projecting over the left upper quadrant over no known vein with air bubbles along its tract. US subsequently showed the tip of the first umbilical venous catheter was in the subcutaneous tissues of the anterior abdominal wall.

The diagnosis was perforation of the first umbilical venous catheter out of the vein lumen and high malposition of the second umbilical venous catheter in the atrium.

Premature newborn after umbilical venous catheter placement

AXR of umbilical venous catheter in the left portal vein
CXR AP shows the tip of the umbilical venous catheter projecting over the left portal vein. The tip of the umbilical arterial catheter projects at T6. There is hazy ground glass opacity in the lungs.

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