Radiological case of the month. Perforation of the inferior cava as a cause of neonatal free intra-abdominal air

Extravasation of hyperalimentation into the liver parenchyma from a peripherally inserted central catheter

A neonate receiving hyperalimentation through a peripherally inserted central catheter (PICC) had acute abdominal distension and respiratory distress. She was found to have extravasated a 9-cm x 9-cm pocket of hyperalimentation into the liver parenchyma, most likely caused by arterial placement of the PICC. She had severe anasarca and markedly decreased synthetic liver function. After 3 weeks of intensive care, she began to diurese. Her respiratory status subsequently improved, she started feeding, and her liver function test results returned to normal. This case shows the remarkable regenerative capacity of the neonatal liver and provides a rationale for conservative management of this rare but morbid PICC complication.