Objectives: Umbilical venous catheter (UVC) insertion is a common procedure in neonatal intensive care units. It is used as central line access for infusion of fluids, medication, TPN etc. and for central venous pressure monitoring. Complications are rare and include vascular injury, liver injury (laceration, hematoma, necrosis, abscess) and portal vein thrombosis. Most of the parenchymal liver complications are related to misplacement of the catheter.
The aim of our study is to describe the clinical and radiologic characteristics of UVC related complications in the liver.
Material and Methods: A retrospective review of cases of neonates with parenchymal liver changes associated with the presence of UVC between 02/2014-08/2017. Demographics, clinical and radiologic data were collected.
Results: Overall 10 cases were reviewed (7 males). Average age at diagnosis was 16.8±23 days (range 1-77 days). Average time between the documented misplacement of the catheter and the first ultrasound 8.6±8.5 days.
Three patients were symptomatic (sepsis and abdominal distention) at the time of the ultrasound. In 7 cases, liver lesions were an incidental finding in an ultrasound done for another purpose. Average age at diagnosis in the symptomatic patients was 9±7 days (range 1-77 days) vs. 20.1±27.1 days (range 2-16 days) in the asymptomatic patients.
Sonographic findings included: hypoechoic lesion with hyperechoic rim (2 patients), single hyperechoic lesion (4 patients) and multiple hyper-echoic lesions (5 patients). Lesions volume range was 0.05-52.8cc (Average 10.4±16.6, 18±30.2cc in symptomatic patients and 6.6±4.7cc in asymptomatic patients). Parenchymal heterogeneity and left portal vein thrombosis were seen in one patient. CT and MRI were done in 2 cases, with similar findings of a single liver lesion containing fat and calcifications (mimicking teratoma). Both patients were asymptomatic.
Treatment: the UVC was removed in all cases. Symptomatic patients were treated with antibiotics. Asymptomatic patients had routine sonographic follow-up without any additional treatment.
Conclusions: Misplacement of UVC can cause several types of liver injuries. In our study, most of the parenchymal injuries were asymptomatic and were found incidentally. No specific imaging features could distinguish between symptomatic or asymptomatic patients. Treatment should be based on clinical assessment. If asymptomatic, no treatment is required and ultrasound surveillance can be used to ensure lesion regression.
