Pediatric TPNoma

  • Etiology: Malposition of umbilical venous catheter tip outside of umbilical vein and into liver leading to extravasation of intravenous fluids and total parenteral nutrition into liver
  • Imaging US: Intrahepatic fluid collection which is often hyperechoic in the acute phase and then becomes heterogenous in the subacute phase
  • DDX:
  • Complications: Infection of the TPNoma
  • Treatment: Often resolve spontaneously after removal of umbilical venous catheter
  • Clinical: Presents with hepatomegaly

Radiology Cases of TPNoma

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.
US of TPNoma
Initial AXR AP (above left) shows the umbilical venous catheter (UVC) tip to project over the liver and not to project at the junction of the inferior vena cava and right atrium. The UVC did not work well and was removed several days later. AXR 2 weeks later (above right) shows interval development of hepatomegaly. Transverse (below left) and sagittal (below right) US of the liver show a large septated and complex fluid collection within the liver.

Radiology Cases of Umbilical Venous Catheter Perforation of Vessel With Formation of TPNoma and TPN Ascites

CXR of umbilical venous catheter perforation causing TPNoma in liver and TPN ascites
AXR AP (above left) after line placement shows the tip of the umbilical venous catheter to be inferior to the cavo-atrial junction. The bowel gas pattern is normal. There is a moderate right pleural effusion. AXR AP obtained 1 day later (above right) shows developing mild centralization of the bowel loops and increase in the size of the right pleural effusion. The tip of the umbilical venous catheter now projects over the umbilical vein. AXR AP obtained 1 day later (below left) shows marked centralization of bowel loops. Sagittal US of the right side of the abdomen (below right) shows a large right pleural effusion (left side of image), a large amount of ascites (right side of image anteriorly) and a cystic lesion within the liver (right side of image posteriorly).

Radiology Cases of Umbilical Venous Catheter Distal Placement in Portal Vessel Resulting in Calcification of Portal Vessels

US of TPNoma due to umbilical venous catheter malposition
CXR AP (above) shows the tip of the umbilical venous catheter projecting over the left portal vein. Transverse (below left) and sagittal (below right) US of the left lobe of the liver obtained 4 months later shows hyperechoic branching lesions in the liver which are felt to be calcifications in the distal branches of the portal veins due to long term direct injection of total parenteral nutrition into the distal branches of the portal veins rather than into the inferior vena cava.