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