Category: Cardiovascular

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.

Premature newborn whose newly placed umbilical venous catheter has just been flushed

AXR of portal venous gas from an umbilical venous catheter in the right portal vein
CXR AP shows the tip of the umbilical venous catheter to be in the right portal vein. There is air in the portal venous system. The umbilical arterial catheter projects at T9. There is mild ground-glass opacity in the lungs.

The diagnosis was portal venous gas caused by air being injected through the umbilical venous catheter which was malpositioned in the liver. The umbilical arterial catheter is appropriately positioned in a patient with respiratory distress syndrome.

Premature newborn who has had two umbilical venous catheters placed

AXR of umbilical venous catheters in the left portal vein and right portal vein
AXR AP shows the tip of the first umbilical venous catheter curled back upon itself in the right portal vein with the tip of the second umbilical venous catheter in the left portal vein. The tip of the umbilical arterial catheter is at T7.

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

Premature newborn after placement of two umbilical venous catheters

CXR of umbilical venous catheter in the left pulmonary vein
CXR AP shows one umbilical venous catheter coursing into the right atrium, through a patent foramen ovale, into the left atrium and then into a left pulmonary vein. Another umbilical venous catheter has its tip projecting intrahepatically within the main portal vein. The umbilical arterial catheter tip is at T8.

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

Premature newborn who has had 2 umbilical venous catheters placed

CXR of umbilical venous catheter in right atrium and superior vena cava
CXR AP shows the tip of one umbilical venous catheter to be in the superior vena cava with the tip of the other umbilical venous catheter curled within the right atrium. The tip of the endotracheal tube is in the right mainstem bronchus. The lungs have ground-glass opacity.

The diagnosis was high malposition of the umbilical venous catheters and malposition of the endotracheal tube in a patient with respiratory distress syndrome.

Premature newborn status post umbilical venous catheter placement

CXR of umbilical venous catheter in a pulmonary vein
CXR AP shows the umbilical venous catheter coursing into the right atrium, through a patent foramen ovale, into the left atrium and then into a left pulmonary vein. The umbilical arterial catheter tip is at T4. There is faint ground glass opacity in the lungs.

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

Premature newborn after placement of an umbilical venous catheter

AXR of umbilical venous catheter in appropriate position
AXR AP and cross-table lateral shows normal course of the umbilical venous catheter 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 at the junction of the inferior vena cava and right atrium. The umbilical arterial catheter has a normal course 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 at T5.

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