Journal of Medical Ultrasonics

, Volume 35, Issue 3, pp 119–123 | Cite as

Flaming portal vein as a new color Doppler sign of portal gas: report of two cases

  • Hiroyasu Ijuin
  • Daigo Tokitoku
  • Yoshihiko Atsuchi
  • Tomohisa Kosaihira
  • Mio Nagamine
  • Kayoko Nozaki
  • Takeshi Arima
  • Tetsuya Takahama
  • Hideaki Ishida
Case Report
First Online:
Received:
Accepted:

Abstract

Portal gas is relatively rare, and the majority of reported cases have shown it to have a close relation to bowel diseases. At present, portal exploration usually begins with color Doppler sonography, and clinicians now possess a good understanding of color Doppler findings of a wide spectrum of portal abnormalities. However, the color Doppler sign we present in this article has not been reported before. We report two cases of ischemic bowel disease in which B-mode ultrasound showed multiple hyperechoic spots moving in the portal vein; the color Doppler appearance was as if the portal vein was on fire (flaming portal vein sign). Knowledge of this simple color Doppler sign helps to improve the diagnostic strategies in patients with portal gas.

Keywords

ultrasound Doppler portal vein gas bowel ischemia 
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References

  1. 1.
    Wolfe JN, Evans WA. Gas in the portal veins of the liver in infants. AJR 1955:74:486–489.Google Scholar
  2. 2.
    Fred HL, Mayhall CG, Harle TS. Hepatic portal venous gas: a review and report on six cases. Am J Med 1968;44:557–565.PubMedCrossRefGoogle Scholar
  3. 3.
    Liebman PR, Patten MT, Manny J, et al. Hepatic-portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg 1978;187:281–287.PubMedCrossRefGoogle Scholar
  4. 4.
    Gosink BB. Intrahepatic gas: differential diagnosis. AJR 1981;137:763–767.PubMedGoogle Scholar
  5. 5.
    Dennis MA, Pretorius D, Manco-Johnson ML, et al. CT detection of portal venous gas associated with suppurative cholangitis and cholecystitis. AJR 1985;145:1017–1018.PubMedGoogle Scholar
  6. 6.
    Taylor KJW, Morse SS, Weltin GG, et al. Liver transplant recipients: portable duplex US with correlative angiography. Radiology 1986;159:357–363.PubMedGoogle Scholar
  7. 7.
    Chezmar JL, Nelson RC, Bernardino ME. Portal venous gas after hepatic transplantation: sonographic detection and clinical significance. AJR 1989;153:1203–1205.PubMedGoogle Scholar
  8. 8.
    Kriegshauser JS, Reading CC, King BF, et al. Combined systemic and portal venous gas: sonographic and CT detection in two cases. AJR 1990;154:1219–1221.PubMedGoogle Scholar
  9. 9.
    Lafortune M, Trinh BC, Burns PN, et al. Air in the portal vein: sonographic and Doppler manifestations. Radiology 1991;180:667–670.PubMedGoogle Scholar
  10. 10.
    Lee CS, Kuo YC, Peng SM, et al. Sonographic detection of hepatic portal venous gas associated with suppurative cholangitis. J Clin Ultrasound 1993;21:331–334.PubMedCrossRefGoogle Scholar
  11. 11.
    Tsubono T, Sato K, Fukuda M. Hepatic portal venous gas associated with cholangitis following pancreaticoduodenectomy: report of a case. Surg Today 1994;24:375–377.PubMedCrossRefGoogle Scholar
  12. 12.
    Schulze CG, Blum U, Haag K. Hepatic portal venous gas. Acta Radiol 1995;36:377–380.PubMedGoogle Scholar
  13. 13.
    Yoshida M, Mitsuno M, Kutsumi H, et al. A successfully treated case of multiple liver abscesses accompanied by portal venous gas. Am J Gastroenterol 1996;91:2423–2425.PubMedGoogle Scholar
  14. 14.
    Faberman RS, Mayo-Smith WW. Outcome of 17 patients with portal venous gas detected by CT. AJR 1997;169;1535–1538.PubMedGoogle Scholar
  15. 15.
    Hong JJ, Gadaleta D, Rossi P, et al. Portal vein gas, a changing clinical entity: report of seven patients and review of the literature. Arch Surg 1997;132:1071–1075.PubMedGoogle Scholar
  16. 16.
    Brown MA, Hauschildt JP, Casola G, et al. Intravascular gas as an incidental finding at US after blunt abdominal trauma. Radiology 1999;210:405–408.PubMedGoogle Scholar
  17. 17.
    Zhang D, Weltman D, Baykal A. Portal vein gas and colonic pneumatosis after enema with spontaneous resolution. AJR 1999;173:1140–1141.PubMedGoogle Scholar
  18. 18.
    Draghetti MJ, Salvo AF. Gas in the mesenteric vein as a nonfatal complication of diverticulitis: report of a case. Dis Colon Rectum 1999;42:1497–1498.PubMedCrossRefGoogle Scholar
  19. 19.
    Wakisaka M, Mori H, Kiyosue H, et al. Septic thrombosis of the portal vein due to peripancreatic ligamental abscess. Eur Radiol 1999;9:90–92.PubMedCrossRefGoogle Scholar
  20. 20.
    Sebastia C, Quiroga S, Espin E, et al. Portomesenteric vein gas: pathologic mechanism, CT findings, and prognosis. Radiographics 2000;20:1213–1224.PubMedGoogle Scholar
  21. 21.
    Morrison SC, Czinn S. Portal vein gas associated with rotavirus infection. J Pediatr Gastroenterol Nutr 2001;33:626–628.PubMedCrossRefGoogle Scholar
  22. 22.
    Maher MM, Tonra BM, Malone DE, et al. Portal venous gas: detection by gray-scale and Doppler sonography in the absence of correlative findings on computed tomography. Abdom Imaging 2001;26:390–394.PubMedCrossRefGoogle Scholar
  23. 23.
    Chevallier P, Peten E, Souci J, et al. Detection of portal venous gas on sonography, but not on CT. Eur Radiol 2002;12:1175–1178.PubMedCrossRefGoogle Scholar
  24. 24.
    Wiesner W, Mortele KJ, Glickman JN, et al. Portal venous gas unrelated to mesenteric ischemia. Eur Radiol 2002;12:1432–1437.PubMedCrossRefGoogle Scholar
  25. 25.
    Hou SK, Chern CH, How CK, et al. Hepatic portal venous gas: clinical significance of computed tomography findings. Am J Emerg Med 2004;22:214–2148.PubMedCrossRefGoogle Scholar
  26. 26.
    Karaosmanoglu D, Oktar SO, Arac M, et al. Portal and systemic venous gas in a patient after lumbar puncture. Br J Radiol 2005;78:767–769.PubMedCrossRefGoogle Scholar
  27. 27.
    Ruiz DSM, de Perrot T, Majno PE. A case of portal venous gas secondary to acute appendicitis detected on gray-scale sonography but not on computed tomography. J Ultrasound Med 2005;24:383–386.PubMedGoogle Scholar
  28. 28.
    Negro U, Verdecchia M, Paci E, et al. Hepatic portal venous gas in a patient with enterovascular fistula. Abdom Imaging 2006;31:706–709.PubMedCrossRefGoogle Scholar
  29. 29.
    Silva CT, Daneman A, Navarro OM, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatr Radiol 2007;37:274–282.PubMedCrossRefGoogle Scholar
  30. 30.
    Yagisawa H, Ishida H, Komatsuda T, et al. Portal gas in a patient with acute obstructive cholangitis: report of a case with emphasis on US findings. J Med Ultrasonics 2007;34:201–204.CrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2008

Authors and Affiliations

  • Hiroyasu Ijuin
    • 1
  • Daigo Tokitoku
    • 1
  • Yoshihiko Atsuchi
    • 1
  • Tomohisa Kosaihira
    • 1
  • Mio Nagamine
    • 2
  • Kayoko Nozaki
    • 2
  • Takeshi Arima
    • 3
  • Tetsuya Takahama
    • 3
  • Hideaki Ishida
    • 4
  1. 1.Department of Internal MedicineTenyokai Chuo HospitalKagoshimaJapan
  2. 2.Department of Clinical LaboratoryTenyokai Chuo HospitalKagoshimaJapan
  3. 3.Department of SurgeryTenyokai Chuo HospitalKagoshimaJapan
  4. 4.Center of Diagnostic Ultrasound and Department of RadiologyRed Cross HospitalAkitaJapan

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