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AN INFANT weighing 1530 g and born at 31 weeks' gestation by emergency cesarean delivery was intubated in the delivery room because of respiratory distress. Endotracheal surfactant was administered, and she was transferred to the neonatal intensive care unit. Within an hour, high-frequency oscillation ventilation was started because of difficulty maintaining oxygenation with conventional ventilation. A double-lumen 3F catheter was inserted into an umbilical vein. The baby's clinical condition improved rapidly over the next 2 days, and she was extubated and maintained on continuous positive airway pressure. At age 4 days, she was breathing room air spontaneously.
On day 5, her abdomen was distended, and she developed respiratory distress and was intubated. The umbilical venous catheter (UVC) was removed because of clinical suspicion of necrotizing enterocolitis. A radiograph of the abdomen was obtained (Figure 1). An ultrasound examination of the abdomen showed echolucency in both flanks indicating free fluid. The kidneys were not identified, but the liver and spleen were normal. Pigtail catheters (4F) were inserted by ultrasound guidance into the flank regions bilaterally. Ninety milliliters of opalescent, blood-stained fluid was aspirated, 50 mL from the right flank and 40 mL from the left flank. Contrast medium was injected via the catheters (Figure 2). Ultrasound following this procedure showed normal kidneys. A laparotomy was performed and showed no necrotizing enterocolitis, perforated viscus, or any other intraperitoneal abnormality. The infant recovered, and findings from ultrasound examination of the abdomen prior to discharge on day 53 was normal.
Walsh JG, O'Sullivan MJ, Ryan CA. Radiological Case of the Month. Arch Pediatr Adolesc Med. 2001;155(4):523–524. doi:10.1001/archpedi.155.4.523
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