Umbilical venous catheter malposition

Imaging description A seven-day-old premature neonate presented with elevated liver enzymes and concern for a liver mass. Review of the outside CT scan of the abdomen showed a hypodense non-enhancing lesion in the right lobe of the liver (Fig. 42.1a). The outside ultrasound of the abdomen demonstrated a large thick-walled multilobulated cystic lesion with multiple septations (Fig. 42.1b). Repeat ultrasound (US) after transfer included color Doppler imaging which demonstrated the lesion to be cystic and avascular with mild perilesional hyperemia (Fig. 42.1c). Review of the outside chest radiographs revealed an abnormal anterior course of the umbilical venous line on the lateral view (Fig. 42.1d, e). The pediatric radiologist therefore suggested that rather than a neoplasm the liver “mass” represented a fluid collection/hematoma secondary to malposition of the umbilical venous line into the liver parenchyma with hemorrhage and fluid extravasation. A follow-up US at five months demonstrated complete resolution of the lesion with residual calcification in the liver.