WWWTP #21… Answer

October 28, 2014

WWWTP


This is an interesting X-ray of a newborn with respiratory distress:

WWWTP 21

WWWTP 20

 

The upper Chest X-ray has an endotracheal tube near the carina (probably should be pulled back a bit).  It also has cardiomegally with vascular congestion.  The line coming up from below is an umbilical venous catheter in the inferior vena cava.

The “baby gram” below shows the same.  This image gives a better view of the umbilical line.

An umbilical venous catheter should traverse as this one does.  It comes straight up from the umbilicus to just above the diaphragm near the right atrium and inferior vena cava junction.  If the catheter does not go straight up and veers to the left side of the patient, it may have erroneously entered the hepatic vasculature.  This can result in hepatic complications.

The patient ended up having a double outlet right ventricle (both the aorta and main pulmonary artery are attached to the right ventricle) which is one of many anatomic heart abnormalities that can lead to congestive heart failure.  There was also a patent ductus arteriosus and a large ventral septal defect (VSD) that allowed for mixing of deoxygenated and oxygenated blood.  Without the large VSD the patient would not have been able to survive.

Author:  Russell Jones, MD

 

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EMREMS: Radiology in Emergency Medicine

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