Newborn after umbilical arterial catheter placement

AXR of low malposition of an umbilical arterial catheter — AXR supine shows an umbilical arterial catheter that loops back upon itself in the aorta and whose tip projects in the right iliac artery at S3. The umbilical venous catheter tip projects at the junction of the inferior vena cava and the right atrium.

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

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 now 2 weeks old with sepsis who had an umbilical arterial catheter placed at birth which was removed after a week

US of aortic thrombus due to umbilical arterial catheter — Sagittal and transverse grayscale US of the aorta shows an echogenic, linear object within the aorta which on color doppler US was seen to have blood flow around it.

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

Premature newborn after umbilical arterial and umbilical venous catheter placement

AXR of umbilical arterial catheter perforation — Supine AXR shows the tip of the umbilical arterial catheter to project in the left abdomen over no known arterial vessel. The tip of the umbilical venous catheter projects within the liver.

The diagnosis was perforation of the umbilical arterial catheter out of the arterial lumen and low malposition of the umbilical venous catheter within the liver.

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 midline defect including a split anterior half of the sternum, a thoracoabdominal ectopic cordis, and an omphalocele

CXR of Pentalogy of Cantrell — CXR and AXR shows the cardiac margin to be absent below the level of the diaphragm. The left lung is hyperlucent compared to the right. There is a paucity of bowel gas within the abdomen and centralization of bowel loops

The diagnosis was Pentalogy of Cantrell and ascites.

Infant with congenital diaphragmatic hernia on arterial-venous ECMO

CXR of arterial-venous extracorporeal membrane oxygenation (ECMO) — CXR shows normal position of the arterial catheter tip in the aortic arch and abnormal position of the venous catheter tip (represented by a radio-opaque point) in the superior vena cava. Further advancement of the tip into the right atrium is necessary.

The diagnosis was abnormal position of the venous ECMO catheter tip.

Teenager with viral pneumonia on arterial-venous (AV) ECMO

AXR of arterial-venous extracorporeal membrane oxygenation (ECMO) — AXR shows normal position of the arterial catheter tip in the right iliac artery and normal position of the venous catheter tip in the mid inferior vena cava.

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

Infant with viral pneumonia on venous-venous (VV)ECMO

CXR of venous-venous extracorporeal membrane oxygenation (ECMO) — CXR shows normal position of the venous catheter tip near the junction of the right atrium and the inferior vena cava.

The diagnosis was normal position of the VV ECMO catheter tip in an infant.

Newborn with persistent pulmonary hypertension on venous-venous (VV) ECMO

CXR of venous-venous extracorporeal membrane oxygenation (ECMO) — CXR shows normal position of the venous catheter tip in the right atrium.

The diagnosis was normal position of the VV ECMO catheter tip in a neonate.

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.

Newborn with persistent pulmonary hypertension 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 (aa) and normal position of the venous catheter tip in the right atrium (ra).

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

Teenager status post central catheter placement

CXR showing central venous catheter tip malpositioned in the right internal thoracic vein — CXR AP obtained immediately after catheter placement (above) shows the catheter tip malpositioned in the right internal thoracic vein. CXR AP obtained after repositioning (below) shows catheter tip appropriately positioned in the superior vena cava.

The diagnosis was malpositioned catheter tip after placement.

Preschooler with a dual port central catheter whose white port is not working well

Line study showing dual port central venous catheter — Image from a line study while injecting the white port of the catheter (left lower) shows the lumen of the white port is one-third the diameter seen while injecting the red port of the catheter (right lower). No fibrin sheath or clot was seen.

The diagnosis was a normal appearance of a dual port central catheter.

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.

Preschooler with a catheter that does not draw back

Line study of an occluded central venous catheter due to migration — CXR from 3 months before (above) shows the tip of the catheter in appropriate position in the superior vena cava. Scout image from the line study (below) shows interval migration of the tip of the catheter so that its tip now lies nearly flush against the lateral wall of the superior vena cava.

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

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.

Preschooler with a catheter that infuses but does not draw back

Line study of occluded central venous catheter due to migration — Scout image from a line study shows migration of the tip of the catheter so that it now lies flush against the lateral wall of the superior vena cava.

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

Teenager 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 the tip of the catheter in the superior vena cava. Injection of contrast (below) shows staining of a large irregularly shaped object resembling thrombus at the tip of the catheter.

The diagnosis was thrombus of the catheter tip.

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.