One of the complications of a malpositioned umbilical venous catheter is the formation of a complicated intrahepatic fluid collection ¹. This is due to the infusion of hypertonic fluid, including TPN^1. Hence, the collection can be called a TPNoma when it's due to a TPN infusion. In this instance, there is a confirmed infusion of both TPN and hypertonic fluid.

Acute collections appear as homogeneous, hyperechoic, or echogenic mass-like lesions, while subacute collections appear heterogeneous with an echogenic rim and hypoechoic center containing cystic areas due to tissue necrosis ¹.

The collection was confirmed on the day 7 ultrasound and appeared subacute based on the above description, with a well-identified, irregular, and mixed appearance sonographically.

The collection was likely infected too, with the appreciation and identification of gaseous locules on the day 5 portable X-ray and a solitary circumscribed lucency on the day 7 X-ray.

The neonate was treated with intravenous antibiotics during the intensive care stay with the removal of the malpositioned umbilical venous line. The infected TPNoma/hepatic abscess was resolved through conservative management without the need for interventional percutaneous aspiration.