Malposition of a Peripherally Inserted Central Catheter Into the Internal Vertebral Venous Plexus in a Neonate With Central Nervous System Malformations

Peripherally inserted central catheters (PICCs) are widely used in neonatal intensive care units (NICUs); however, malposition into the paravertebral venous system is a rare but potentially life-threatening complication. Migration of a PICC into the internal vertebral venous plexus is particularly uncommon, and direct imaging confirmation of this pathway has rarely been reported. We report a term neonate with myelomeningocele, Chiari II malformation, and hydrocephalus in whom a PICC inserted via the left great saphenous vein migrated from the ascending lumbar vein into the internal vertebral venous plexus. Chest-abdominal radiography was obtained for catheter position confirmation, and computed tomography (CT) imaging was subsequently performed for preoperative assessment of the myelomeningocele. CT imaging incidentally but definitively demonstrated the continuous migration pathway of the catheter into the spinal canal. The catheter was removed before the initiation of hyperosmolar infusions, and no complications occurred. Malposition of PICCs into the internal vertebral venous plexus poses a substantial risk of severe neurological and potentially fatal complications. In the present case, CT imaging enabled precise anatomical confirmation of catheter migration that could not be achieved by plain radiography alone. To the best of our knowledge, this is the first neonatal case in which migration of a PICC from the ascending lumbar vein into the internal vertebral venous plexus was precisely demonstrated using CT imaging. This case underscores the importance of careful catheter position assessment and highlights the conditional but critical role of CT in accurately diagnosing dangerous PICC malposition.