Applied Radiology

Prepared by Daniel Fagerson, MD; Brian Hopkins, MD; and Alfred Horowitz, MD of the Radiology Department, Resurrection Medical Center, Chicago, IL.

CASE SUMMARY

A 3-month-old girl was admitted to the emergency department with a history of abdominal pain and emesis. Her medical history was notable for meconium aspiration syndrome and sepsis at birth that required antibiotics for 7 days, during which time both her umbilical artery and vein were catheterized for monitoring and drug administration. Daily radiography confirmed the arterial catheter tip position constant at the level of the sixth thoracic vertebrae (figure 1). Physical examination on admission demonstrated a right flank abdominal mass with minimal guarding. Ultrasound and CT images were obtained (figures 2 and 3) and the patient was then taken to surgery.

DIAGNOSIS

Ovarian infarction presumed secondary to umbilical artery catheterization. Differential considerations included Wilm's tumor, neuroblastoma, a mesenteric cyst, and enteric duplication. At surgery, a purple, ovoid, well-circumcised necrotic mass was excised and pathology confirmed an infarcted ovary.

DISCUSSION

Umbilical artery catheterization is performed most commonly in neonates for measurement of arterial blood gases and blood pressure. A 4F catheter is introduced into the umbilical artery and passes into the aorta via the (left or right) internal iliac artery. Positioning of the catheter tip can be either high or low in order to avoid renal artery damage. The high position is at the level of the sixth to ninth thoracic vertebral bodies and the low position is at the third to fourth lumbar vertebral bodies.

Reported complications of a malpositioned umbilical artery catheter include renal artery thrombosis, aortic thrombosis, necrotizing enterocolitis, ischemia to the lower extremities and spine, and sepsis. As far as we are aware, this is the first reported case of ovarian infarction occurring due to umbilical artery catheterization. Other potential causes of ovarian infarction in a neonate are very rare and include torsion, emboli, and disseminated intravascular coagulation. To prevent complications, it is essential that malpositioning of umbilical artery catheterization is recognized and reported so that proper repositioning of the catheter can be obtained before blood sampling or medication infusion.

REFERENCES

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