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 a left congenital diaphragmatic hernia on arterial-venous (AV) ECMO

CXR of arterial-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the arterial catheter tip in the aortic arch and normal position of the venous catheter tip in the right atrium, both of which are shifted to the right by the diaphragmatic hernia. Note that the endotracheal tube, which is positioned between the two ECMO catheters, is also shifted to the right.

The diagnosis was normal position of the AV ECMO catheter tips in a neonate.

School ager who presents with back pain after having a central venous catheter replaced 5 months ago

CXR and CT of embolized central venous catheter fragment
CXR AP shows the tip of the new catheter to be in appropriate location in the superior vena cava. There is a catheter fragment in the right lower lobe along with a large right pleural effusion. Axial CT with contrast of the chest shows the embolized catheter fragment in the periphery of the right lower lobe and to have eroded into the right pleural space, with an associated pleural effusion and atelectasis.

The diagnosis was an embolized catheter fragment after catheter removal.

School ager with a catheter that infuses but does not draw back

Line study of a thrombus on a central venous catheter
Scout image from a line study (above) shows migration of the tip of the catheter 90 degrees so that it now lies flush against the anterior wall of the superior vena cava. AP and lateral views from the line study after contrast injection shows staining of a long thin object resembling thrombus hanging off the tip of the catheter.

The diagnosis was thrombus of the catheter tip and occlusion of the catheter tip due to catheter migration.

Teenager with a catheter that infuses but does not draw back

Line study of a fibrin sheath on a central venous catheter
Image from a line study (above) with the catheter filled with contrast shows a mild dilation in the diameter of the distal catheter, suggesting the contrast is inside a sheath encasing the distal catheter. When contrast is injected through the catheter (below), a sheath is seen to flip off the tip of the catheter to the left.

The diagnosis was fibrin sheath of the catheter tip.