E1750. The Undulating Line Sign and Other More Common Pediatric Central Catheter Misadventures
  1. Aki Tanimoto; Seattle Children's Hospital; University of Washington
  2. Luana Stanescu; Seattle Children's Hospital; University of Washington
  3. Jeffrey Otjen; Seattle Children's Hospital; University of Washington
  4. Dennis Shaw; Seattle Children's Hospital; University of Washington
  5. Teresa Chapman; Seattle Children's Hospital; University of Washington
Radiographic evaluation of central venous and arterial catheters is commonplace in pediatric patients. The position of these catheters must be carefully assessed to ensure proper placement as malpositioning may lead to life threatening consequences. Therefore, it is important for radiologists to understand the anatomy of the central vessels and expected location of catheters. While this can be difficult in small children, especially neonates, knowledge of the expected course and ideal location of catheter tips can help aid in the diagnosis of a malpositioned line, which may be unsuspected clinically.

Educational Goals / Teaching Points
In order to increase awareness of these potential errors and to improve diagnostic accuracy, in this exhibit we review educational examples of malpositioned central vascular catheters. Upon completion of the educational presentation, the learner will be able to describe normal central vascular anatomy, including the course of the umbilical arteries and vein; recognize expected catheter position; and identify malpositioned central lines on radiographs.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiographs demonstrating malpositioned catheters are displayed in an electronic, anonymized format. The learner is presented with examples of normally positioned catheters alongside pathologic cases.

Careful evaluation of central vascular catheter position and solid understanding of the expected course of these catheters is essential to identify malpositioned catheters, which may only be diagnosed radiographically. We hope to improve awareness and increase the confidence, not only of residents but of adult radiologists when they interpret pediatric exams.