PMC5606054_01
Anterior-posterior portable radiographs (a) and cross-table lateral radiograph (b) demonstrating the abnormal course of the umbilical catheter. The anterior-posterior view illustrates the caudal loop (solid arrow) as well as the superior ascent of the umbilical catheter to the right atrium (dashed arrow). The inset image of a subsequent anterior-posterior image reveals the close proximity of the umbilical catheter (solid arrow) and the peripherally inserted central venous catheter placed (dashed arrow) in the arm. The lateral radiograph reveals the position of the umbilical catheter (solid arrow) anterior to the expected position of the aorta.
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However, the tip of the line was ultimately located to the right of the vertebral column (Figure 1(a)). This demonstrated the tip of the umbilical line projecting over the expected location of the right atrium, at the level of the lower thoracic spine, and anteriorly and to the right of the expected position of the aorta (Figure 1(b)).
Sonographic imaging demonstrating the tip of the catheter (solid arrow) within the inferior vena cava (and not within the aorta). Also note that the size of the inferior vena cava is prominent.
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Instead, the catheter was identified within the inferior vena cava, with the tip positioned at the lower cavoatrial junction (Figure 2).
PMC5606054_02
Sonographic imaging demonstrating the umbilical catheter (solid arrow) within the left iliac vein (dashed arrow) in close proximity to the bladder.
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Further Doppler ultrasound imaging demonstrated an umbilical vein, which coursed inferiorly into the left iliac vein (Figure 3).
Transverse (a) and longitudinal (b) prenatal sonographic images demonstrating atypical umbilical venous anatomy at the level of the bladder. The transverse image demonstrates vessels coursing from the umbilicus into the fetus on either side of the bladder but with different Doppler flow directions indicating umbilical artery and vein. The longitudinal image demonstrates cord insertion and both arterial and venous flow into the fetal pelvis prior to joining the iliac vessels. Of note, there is no Doppler flow from cord insertion directly to the liver.
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The patient's obstetrical records were obtained from the outside healthcare system, and these indicated a suspicion of atypical umbilical venous anatomy seen during prenatal ultrasound (Figure 4).