Presentation
36-week premature delivery with respiratory distress and post insertion of umbilical venous catheter.
Patient Data
Hyperinflated lung fields with surfactant deficiency disorder. Normal cardiomediastinal contour with a central trachea.
The nasogastric tube is satisfactorily sited. There are overlying ECG leads and a temperature lead.
The umbilical venous catheter (UVC) is malpositioned. There are no intrahepatic lucencies.
The bowel gas pattern is non-specific with no features of necrotizing enterocolitis (NEC).
The follow-up X-ray was performed 10 minutes later.
There is attempted UVC resiting, but it remains malpositioned. There are new punctate intrahepatic portal venous lucencies. This is easily identified on the zoomed and reverse window images.
The chest and abdomen are otherwise static in comparison to the initial X-ray.
Case Discussion
The portable supine chest and abdominal X-ray were taken promptly after birth and insertion of the UVC. In this instance, the portal venous gas identified on the follow-up X-ray is due to an exogenous source and is related to the manipulation of the malpositioned UVC. There is a confirmed stable condition and absence of any clinical symptoms of NEC.
The rapidity of imaging post insertion/ manipulation of a malpositioned UVC often alludes to the diagnosis of exogenous portal venous gas. The absence of clinical signs of NEC further confirms the diagnosis.
The gaseous lucencies can be identified on ultrasound as mobile echogenic intraluminal foci within the portal vein or branches thereof.
Based on personal experience, these lucencies often disappear on follow up imaging while portal venous gas in a setting of NEC may persist a little longer.
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