Purpose or Case Report: Umbilical catheters provide intravascular access in the neonatal period that is lifesaving and relatively easy to obtain. However, they are associated with numerous complications related to their placement and use. These may occur because of injuries to vessels and adjacent structures at the time of or following catheter placement; an example is a liver hematoma caused by focal perforation of the umbilical or portal veins during attempted passage of the catheter into the ductus venosus. Complications may also arise from the use of a malpositioned catheter. Pleural effusions and ascites composed of total parenteral nutrition solutions may result from the use of an umbilical venous catheter that terminates in the portal venous system. Complications may be caused by otherwise well positioned, normally functioning catheters, which are innately thrombogenic and may cause thrombosis of the aorta and branches, portal venous system, or caval tributaries, with potentially devastating consequences. Finally, catheter-associated blood stream infection is always a risk during placement and subsequent use. The resulting bacteremia can lead to life-threatening sepsis and additional complications such as septic thrombosis and mycotic aneurysm. This educational review presents a spectrum of complications related to umbilical catheters, organized according to the framework outlined above. The review includes images of cases illustrating both common and unusual entities and a discussion of their salient imaging and clinical features.
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