AJR:180, April 2003 1147 mbilical venous catheters are commonly used in the neonatal period for vascular access. De- spite their routine use, they are frequently malpositioned and may occasionally be asso- ciated with complications. Furthermore, an unusual course of an umbilical venous cathe- ter may aid in the diagnosis of cardiovascular or other anomalies. We review the normal vascular course and radiographic appearance of umbilical venous catheters, several com- mon and rare anomalous positions of umbili- cal venous catheters, potential complications associated with umbilical venous catheters, and unusual courses of these catheters that may provide clues to the diagnosis of under- lying anomalies. To provide optimal patient care, the radiologist interpreting neonatal ra- diographs should be familiar with these po- tential anomalous umbilical venous catheter courses and complications. Neonates and Umbilical Venous Catheters: Normal Appearance, Anomalous Positions, Complications, and Potential Aid to Diagnosis Alan E. Schlesinger 1 , Richard M. Braverman 1 , Michael A. DiPietro 2 Received July 12, 2002; accepted after revision August 28, 2002. Presented at the annual meeting of the American Roentgen Ray Society, Seattle, April–May 2001. 1 Edward B. Singleton Department of Diagnostic Imaging, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin St., MC2-2521, Houston, TX 77030. Address correspondence to A. E. Schlesinger. 2 Department of Radiology, C. S. Mott Children’s Hospital, University of Michigan Medical Center, 1500 Medical Center Dr., Ann Arbor, MI 48109-0252. AJR 2003;180:1147–1153 0361–803X/03/1804–1147 © American Roentgen Ray Society Pictorial Essay U A B Fig. 1.—Postmortem venogram in 27-week premature ne- onate shows normal anatomy. Umbilical vein enters left portal vein opposite origin of ductus venosus. Focal dila- tation of umbilical vein just inferior to its insertion into left portal vein is umbilical recess. Ductus venosus begins at left portal vein opposite site of insertion of umbilical vein and courses to inferior vena cava, entering inferior vena cava at or near confluence of inferior vena cava and he- patic veins. (Adapted with permission from [1]) Fig. 2.—Normal radiographic appearance of umbilical venous catheter and umbilical artery catheter. A, Frontal radiograph of abdomen shows that umbilical venous catheter enters abdomen at umbilicus ( small arrowhead), travels in cephalad direction in umbilical vein (double black arrows) (note that catheters cross just above umbilicus), courses through left portal vein and ductus venosus, enters inferior vena cava, and terminates in right atrium. Umbilical artery catheter also enters abdomen at umbilicus ( single black arrow) but extends inferiorly (white arrow) and posteriorly into iliac artery before coursing superiorly in aorta ( large arrowheads). B, Lateral radiograph shows anterior location of umbilical venous catheter in abdomen until catheter reaches inferior vena cava and right atrium. Umbilical artery catheter enters abdomen at umbilicus (arrowhead ) but courses posteriorly as it descends inferiorly in abdomen to enter umbilical artery before ascending in poste- riorly located aorta (arrow). Downloaded from www.ajronline.org by 52.73.204.196 on 05/18/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved