PMC4813072_01
(A and B) USG abdomen shows multiple heteroechoic predominantly hyperechoic lesions in superior segment (black arrow) and predominantly hypoechoic in inferior segment of left lobe and posterior segments of right lobe with large exophytic component (white arrow)
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F1
USG abdomen performed using high-frequency linear transducer (Envisor color Doppler ultrasound; Philips, Bothel, USA) revealed multiple heteroechoic lesions in the left lobe of liver in segment IVA adjacent to the left portal vein [Figure 1A]. Another large heteroechoic lesion with hyperechoic component in the center was seen in IVB segment and posterior segments of the right lobe of liver with a large exophytic component [Figure 1B].
(A and B) CECT abdomen at the level of portal vein bifurcation showing multiple mixed density intraparenchymal hepatic lesions, Lesions show mixed areas of hemorrhage and fat density at the periphery (white arrow in A). Note is made of oedema around left portal vein and its branches (small black arrow in A). Similar large heterodense lesion with exophytic component is seen in segment IVB and posterior segments of right lobe shows fluid collection with areas of hemorrhage (white arrow in B)
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F2
Subsequently, contrast-enhanced computed tomography (CECT) abdomen was done (16-slice Brilliance Scanner, Philips, Haifa, Israel) for the characterization of lesions, which revealed multiple non-enhancing mixed density lesions in the left lobe of liver with areas of blood and fat component at the periphery, with the largest lesion measuring 8.5 cm x 3.3 cm in IVB and the posterior segments of the right lobe having an exophytic component [Figure 2A and B].
(A) Chest and abdominal Radiograph showing the abnormal position of UVC with tip (black arrow) at D10-D11 level likely in hepatic parenchyma (white arrow). The gas medial to the catheter outlines the umbilical venous recess. Note is made of umbilical artery catheter with tip lying in midline at the level of D10 vertebra (small black arrow). Note is made of reticulonodular shadowing in bilateral lung. (B) Zoomed image shows the air in the branches of left portalvein (black arrow) and hepatic parenchyma (white arrow)
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F3
As there was history of umbilical vein catheterization, previous abdominal radiograph was reviewed which showed the abnormal position of the catheter at D10-D11 level in the right hypochondrium with the tip likely in hepatic parenchyma [Figure 3].
Follow up USG and CECT after 3 weeks show marked regression in the size of the lesions. The lesions in left lobe in superior segment (arrow in A) are more echogenic. Large exophytic lesion with areas of hemorrhage (arrow in B) also shows significant reduction in the size and is more hypoechoic consistent with resolving hematoma. Peripheral foci of calcification was also seen (small arrow in B). Similar changes were appreciated on CT images with decrease in the size and the hematoma is resolving and appear hypodense (C and D)
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F4
The lesions in the left lobe appeared hyperechoic with fine calcification present at places [Figure 4].