title: Femoral venous catheter: a misleading cause of gas in the liver.
abstract: OBJECTIVE
  The presence of a femoral venous catheter could be associated with gas presence in the hepatic veins. This entity should be recognized to avoid a misdiagnosis of gas presence in the portal veins or in the biliary tract. Objectives are to assess: 1) the incidence of gas presence in the hepatic veins in intensive care unit patients explored by abdominal computed tomography scan; 2) the rate of gas presence in the liver in intensive care unit patients with a catheter inserted in the femoral vein; and 3) the specific imaging features.
  
  
  METHODS
  A retrospective study in a medical intensive care unit in a teaching hospital in France.
  
  
  METHODS
  All consecutive abdominal computed tomography scans performed in intensive care unit patients between 2008 and 2010 were retrospectively reviewed independently by an intensivist and a radiologist. Presence of gas in the liver was noticed and its location was specified using multiplanar reconstruction.
  
  
  RESULTS
  We analyzed 235 computed tomography scans (performed in 207 patients). Gas was identified in the liver on 10.2% of computed tomography scans. Gas was located in the hepatic veins in 12 cases (50%), in the biliary tract in ten cases (41.7%), and in the portal veins in two cases (8.3%). All patients with gas in the hepatic veins had a femoral venous catheter. Characteristics of gas location within the hepatic veins on computed tomography scan axial views were not different from those of gas located in the biliary tract or in the portal venous system. Gas was present in the hepatic veins in 12 of 83 (14.5%) of the computed tomography scans with a femoral venous catheter and was associated with gas presence in other vessels of the inferior vena cava system in five of 12 (41.7%) cases.
  
  
  CONCLUSIONS
  Gas located in the hepatic veins related to femoral venous catheter is a frequent cause of gas in the liver in intensive care unit patients. This imaging feature could be misleading. Multiplanar reconstruction should be performed to differentiate this aspect from those of gas in the biliary tract or in the portal venous system.
authors.affiliation: AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, INSERM UMR_S 938, CdR Saint-Antoine, Paris, France. galbois@gmail.com
authors.forename: Arnaud
authors.initials: A
authors.lastname: Galbois
authors.forename: Julien
authors.initials: J
authors.lastname: Cazejust
authors.forename: Lionel
authors.initials: L
authors.lastname: Arrivé
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boëlle
authors.forename: Hafid
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Baudel
authors.forename: Mikael
authors.initials: M
authors.lastname: Alves
authors.forename: Dimitri
authors.initials: D
authors.lastname: Margetis
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D005268:Femoral Vein; D005740:Gases; D006503:Hepatic Veins / Q000503:physiopathology*; D006801:Humans; D007362:Intensive Care Units; D008107:Liver Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D005740:Gases