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• W3044481586 abstract "A female neonate born at 41 weeks of gestation was admitted to the neonatal intensive care unit and required mechanical ventilation due to meconium aspiration syndrome. An umbilical vein catheter (UVC) was inserted for initial venous access. The tip was drawn 2 cm backward to the site below the liver (low position) due to initial malpositioning (Supplementary Figure S1). The endotracheal tube was removed, and the UVC was replaced with a peripherally inserted central catheter on the fifth day of life. A follow-up echocardiogram revealed an oval lesion in the inferior vena cava (IVC) on the ninth day of life (Fig. 1A). The patient's body fluid balance was monitored carefully. Hemoglobin level (14.9 g/dl), hematocrit percent (44.0%), platelet count (111,000/μl), clotting time, liver function group, and blood culture results were normal at the time. Abdominal ultrasonography (Fig. 1B) (Supplementary Figure S2) and computed tomography scan (Fig. 2) showed total thrombosis of the ductus venosus (DV). The patient showed no significant hemodynamic impairment after birth and no other occlusive thrombi in the portal veins or its branches; therefore, she received conservative management. Six months later, a follow-up ultrasonogram showed substantial resolution of the thrombus.Figure 2An abdominal computed tomography scan revealed a dense curvilinear calcification in the fissure for the ligamentum venosum of the liver. No other abdominal venous thrombosis was noted.View Large Image Figure ViewerDownload Hi-res image Download (PPT) In this patient, the thrombus was likely formed after birth because prenatal thrombosis of the DV usually causes acute fetal distress and can be lethal. The ideal tip position of the UVC is at the junction of the right antrum and IVC.1Simanovsky N. Ofek-Shlomai N. Rozovsky K. Ergaz-Shaltiel Z. Hiller N. Bar-Oz B. Umbilical venous catheter position: evaluation by ultrasound.Eur Radiol. 2011; 21: 1882-1886Crossref PubMed Scopus (64) Google Scholar A study reported that only 46% of UVCs were adequately positioned, and the risk factors for portal venous thrombosis included severe neonatal sickness and UVC placement, especially in intrahepatic and low positions.2Morag I. Epelman M. Daneman A. Moineddin R. Parvez B. Shechter T. et al.Portal vein thrombosis in the neonate: risk factors, course, and outcome.J Pediatr. 2006; 148: 735-739Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar Mechanical or chemical irritation of the vessel wall by a catheter is believed to contribute to thrombosis.2Morag I. Epelman M. Daneman A. Moineddin R. Parvez B. Shechter T. et al.Portal vein thrombosis in the neonate: risk factors, course, and outcome.J Pediatr. 2006; 148: 735-739Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar Morag et al. suggested that anticoagulation therapy included occlusive grade 3 portal vein thrombosis, presence of a second thrombus, and postcardiac surgery.2Morag I. Epelman M. Daneman A. Moineddin R. Parvez B. Shechter T. et al.Portal vein thrombosis in the neonate: risk factors, course, and outcome.J Pediatr. 2006; 148: 735-739Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar Early detection using ultrasonography and follow-up for all newborns with UVC displacement are important because occlusive thrombosis affecting other portal veins or branches may cause potentially serious long-term complications such as portal hypertension and lobar atrophy.2Morag I. Epelman M. Daneman A. Moineddin R. Parvez B. Shechter T. et al.Portal vein thrombosis in the neonate: risk factors, course, and outcome.J Pediatr. 2006; 148: 735-739Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar,3Morag I. Shah P.S. Epelman M. Daneman A. Strauss T. Moore A.M. Childhood outcomes of neonates diagnosed with portal vein thrombosis.J Paediatr Child Health. 2011; 47: 356-360Crossref PubMed Scopus (21) Google Scholar This article has not been submitted for publication elsewhere. The authors declare no conflicts of interest regarding this manuscript. The following are the Supplementary data to this article:Figure S2A sketch diagram of the hepatic portal circulation and total thrombosis of the ductus venosusView Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3044481586 date "2020-12-01" @default.
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• W3044481586 title "A Rare Case of Total Thrombosis of Ductus Venosus in a Neonate" @default.
• W3044481586 doi "https://doi.org/10.1016/j.pedneo.2020.07.005" @default.
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