Presentation
Premature delivery at 33-week gestation. Progressive abdominal distension with septicemia and respiratory distress.
Patient Data
There are dilated bowel loops with intravenous portal gas. There is no pneumatosis intestinalis and no free intraperitoneal air.
The umbilical venous catheter (UVC) is malpositioned and within a right portal vein / right portal venous branch. The umbilical arterial catheter (UAC) is satisfactorily sited at the T7 vertebral body level (high position).
The nasogastric tube (NGT) is at the gastric fundus and needs to be distally inserted.
The ETT is infraclavicular at the T1/T2 vertebral level.
There are overlying ECG leads and a solitary temperature lead.
There is a mild surfactant deficiency disorder.
The humeral ossification centers are absent, consistent with prematurity.
Branching lucencies within the liver are consistent with portal venous gas in a setting of necrotizing enterocolitis. The UVC is malpositioned.
Case Discussion
Features consistent with necrotizing enterocolitis (NEC) and portal venous gas.
The acute clinical deterioration at day 2 of life coupled with the radiographic findings are concordant with the diagnosis of NEC.
The differential diagnosis of exogenous portal venous gas due to the malpositioned UVC insertion and/or manipulation was considered less likely due to referral history conveying a moderately ill infant (stage IIb- NEC).
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