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.