Clinical-radiologic features and treatment of hepatic lesions caused by inadvertent infusion of parenteral nutrition in liver parenchyma due to malposition of umbilical vein catheters

Background: Umbilical venous catheterization is a common procedure performed in neonatal intensive care units. Hepatic collections due to inadvertent extravasation of parenteral nutrition into the liver have been described previously in literature. Objective: To recognize the clinicoradiologic features and treatment options of hepatic collections due to inadvertent extravasation of parenteral nutrition fluids caused by malpositioning of umbilical venous catheter (UVC) in the portal venous system. Materials and methods: This is a case series describing five neonates during a 6-year period at a single tertiary care referral center, with extravasation of parenteral nutrition into the liver parenchyma causing hepatic collections. Results: All five neonates receiving parenteral nutrition presented with abdominal distension in the second week of life. Two out of five (40%) had anemia requiring blood transfusion and 3/5 (60%) had hemodynamic instability at presentation. Ultrasound of the liver confirmed the diagnosis in all the cases. Three of the five (60%) cases underwent US-guided aspiration of the collections, one case underwent conservative management and one case required emergent laparotomy due to abdominal compartment syndrome. US used in follow-up of these cases revealed decrease in size of the lesions and/or development of calcifications. Conclusion: Early recognition of this complication, prompt diagnosis with US of liver and timely treatment can lead to better outcome in newborns with hepatic collections secondary to inadvertent parenteral nutrition infusion via malposition of UVC.