Umbilical Venous Extravasation in the Liver Mimicking a Hepatic Tumor in a Neonate

Background: Umbilical venous catheter (UVC) malposition is a frequent complication in neonatal intensive care, potentially leading to life-threatening outcomes. Hepatic extravasation is a rare but important consequence that can mimic neoplastic lesions on imaging. This case highlights the diagnostic challenges and radiological mimicry associated with hepatic extravasation, especially in neonates referred from peripheral centers with suspected liver tumors. Clinical Description: A preterm female infant, born at 31 weeks of gestation, was referred on day 15 of life for evaluation of a suspected hepatic tumor. At the referring hospital, she developed abdominal distension, feed intolerance, hepatomegaly, thrombocytopenia, and coagulopathy. Abdominal ultrasound (US) and computed tomography imaging revealed a large heterogeneous hepatic lesion, raising concern for tumor. Despite these findings, the infant remained clinically stable, and serum alpha-fetoprotein levels were normal. The etiology of the lesion remained unclear at the time of referral. Management and Outcome: At our center, the infant underwent repeat laboratory testing and serial imaging. Blood counts, liver function tests, and coagulation profile were normal, and sepsis workup was negative. A retrospective review of radiographs from the referring hospital showed a low-lying UVC tip with surrounding hypolucency, suggesting hepatic extravasation. Conservative management was continued, and serial US showed progressive resolution of the lesion over 18 months. Conclusion: Hepatic extravasation from a malpositioned UVC can closely mimic liver tumors on imaging. A high index of suspicion, even in late referrals, can facilitate timely recognition of this benign, reversible condition.