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Imaging assessment and clinical significance of pneumatosis in adult patients

  • EMERGENCY RADIOLOGY
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Abstract

Gas detection in the bowel wall and in portomesenteric venous vessels in adults has long been related to intestinal infarction and poor outcome; many case reports have shown that pneumatosis may be associated with a large variety of pathological situations, ranging from absolutely benign and asymptomatic forms to abdominal catastrophes. Several studies have been conducted on this topic with different conclusions, probably due to differences in population so that the clinical value of these signs is still questioned. Intestinal pneumatosis, especially if presenting with a band-like pattern and if associated with portomesenteric vein gas, when observed in an acute abdominal setting should raise the suspicion of mesenteric infarct and prompt a careful search for other signs of intestinal involvement, so as not to miss cases of life-threatening intestinal infarct or allow them to further evolve into extensive necrosis with worse prognosis. In this review we illustrate the most relevant aspects of these debated but significant radiological signs.

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References

  1. Wolfe N, Evans WA (1995) Gas in the portal veins of the liver in infants: a roentgenographic demonstration with postmortem anatomical correlation. AJR Am J Roentgenol 74:486–489

    Google Scholar 

  2. Feczko PJ1, Mezwa DG, Farah MC, White BD (1992) Clinical significance of pneumatosis of the bowel wall. Radiographic 12:1069–1078

  3. Liebman PR, Patten MT, Manny J et al (1978) Hepatic-portal venous gas in adults. Ann Surg 187:281–287

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Taourel PG, Deneuville M, Pradel JA et al (1996) Acute mesenteric ischemia: diagnosis with contrast enhanced CT. Radiology 199:632–636

    Article  CAS  PubMed  Google Scholar 

  5. Clark RA (1987) Computed tomography of bowel infarction. JCAT 11:757–762

    CAS  Google Scholar 

  6. Sebastià C, Quiroga S, Espin E et al (2000) Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics 20:1213–1224

    Article  PubMed  Google Scholar 

  7. Baker SR (2000) Invited commentary. Radiographics 20:1224–1226

    Article  PubMed  Google Scholar 

  8. Cho KC, Baker SR (1994) Extraluminal air. Diagnosis and significance. Rad Clin North Am 32:829–844

    CAS  Google Scholar 

  9. Kessler RM, Lentz JC, Abdnenour GC, Poole CA (1981) Mesenteric vascular gas secondary to ischemic bowel in transmensenteric hernia. Radiology 140:645–646

    Article  CAS  PubMed  Google Scholar 

  10. Brinkley AB Jr (1982) Mesenteric vascular gas secondary to ischemic bowel in transmensenteric hernia. Radiology 143:573

    Article  PubMed  Google Scholar 

  11. Scaglione M, Lassandro F, Pinto F et al (2001) Gastric pneumatosis and portal vein gas: incidental findings at helical CT after blunt abdominal trauma. Emerg Radiol 8:162–164

    Article  Google Scholar 

  12. Lamberto S, Vinci S, Salamone I, Racchiusa S (2001) Intrahepatic portal vein gas. Good prognosis with gastric dilatation. Radiol Med 101:508–510

    CAS  PubMed  Google Scholar 

  13. Benson MD (1985) Adult survival with intrahepatic portal venous gas secondary to acute gastric dilatation, with a review of portal venous gas. Clin Radiol 36:441–443

    Article  CAS  PubMed  Google Scholar 

  14. Friedman D, Flancbaum L, Ritter E, Trooskin SZ (1991) Hepatic portal venous gas identified by computed tomography in a patient with blunt abdominal trauma: a case report. J Trauma 31:290–292

    Article  CAS  PubMed  Google Scholar 

  15. Radin DR, Rosen RS, Halls JM (1987) Acute gastric dilatation: a rare cause of portal venous gas. AJR Am J Roentgenol 148:279–280

    Article  CAS  PubMed  Google Scholar 

  16. Haswell DM, Carsky EW (1979) Hepatic portal venous gas and gastric emphysema with survival. AJR Am J Roentgenol 133:1183–1185

    Article  CAS  PubMed  Google Scholar 

  17. Fisher JK (1984) Computed tomography of colonic pneumatosis intestinalis with mesenteric and portal venous air. JCAT 8:573–574

    CAS  Google Scholar 

  18. Zhang D, Weltman D, Baykal A (1999) Portal vein gas and colonic pneumatosis after enema, with spontaneous resolution. AJR Am J Roentgenol 173:1140–1141

    Article  CAS  PubMed  Google Scholar 

  19. Kingsley DD, Albrecht RM, Vogt DM (2000) Gastric pneumatosis and hepatoportal venous gas in blunt trauma: clinical significance in a case report. J Trauma 49:951–953

    Article  CAS  PubMed  Google Scholar 

  20. Torriero F, Macori F, Misiti A et al (1998) A case of gas occurrence in the venous hepato-portal area after blunt abdominal trauma of the abdomen. Radiol Med 96:118–120

    CAS  PubMed  Google Scholar 

  21. Lassandro F, Mangoni di Santo Stefano ML, Maria Porto A et al. Intestinal pneumatosis in adults: diagnostic and prognostic value. Emerg Radiol. 2010 Apr 15 [Epub ahead of print]

  22. Lassandro F, Scaglione M, Rossi G et al (2002) Portomesenteric vein gas: diagnostic and prognostic value. Emerg Radiol 9:96–99

    Article  PubMed  Google Scholar 

  23. Lassandro F, Romano S, Rossi G (2006) Gastric traumatic injuries: CT findings. Eur J Radiol 59:349–354

    Article  PubMed  Google Scholar 

  24. Makiyama H, Kataoka R, Tauchi M et al (2014) Do alpha-glucosidase inhibitors have the potential to induce portal venous gas? Two clinical case reports. Intern Med 53:691–694

    Article  PubMed  Google Scholar 

  25. Flor N, Pricolo P, Rovere A et al (2013) J Med Case Rep 7:205

    Article  PubMed Central  PubMed  Google Scholar 

  26. Shinagare AB, Howard SA, Krajewski KM et al (2012) Pneumatosis intestinalis and bowel perforation associated with molecular targeted therapy: an emerging problem and the role of radiologists in its management. AJR Am J Roentgenol 199:1259–1265

    Article  PubMed  Google Scholar 

  27. Pear BL (1998) Pneumatosis intestinalis: a review. Radiology 207:13–19

    Article  CAS  PubMed  Google Scholar 

  28. Soyer P, Martin-Grivaud S, Boudiaf M et al (2008) Linear or bubbly: a pictorial review of CT features of intestinal pneumatosis in adults. J Radiol 89:1907–1920

    Article  CAS  PubMed  Google Scholar 

  29. Moschetta M, Telegrafo M, Rella L (2014) Multi-detector CT features of acute intestinal ischemia and their prognostic correlations. World J Radiol 6:130–138

    Article  PubMed Central  PubMed  Google Scholar 

  30. Koss LG (1952) Abdominal gas cysts (pneumatosis cystoides intestinorum hominis): an analysis with a report of a case and a critical review of the literature. AMA Arch Pathol 53:523–549

    CAS  PubMed  Google Scholar 

  31. Mao YC1, Lin TC, Wang JD (2009) Education and imaging. Gastrointestinal: benign cause for pneumatosis intestinalis and portomesenteric venous gas. J Gastroenterol Hepatol 24:927

  32. Miralbés M, Hinojosa J, Alonso J, Berenguer (1983) Oxygen therapy in pneumatosis coli. What is the minimum oxygen requirement? J Dis Colon Rectum 26:458–460

  33. Wiesner W, Mortelé KJ, Glickman JN (2001) Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome. AJR Am J Roentgenol 177:1319–1323

    Article  CAS  PubMed  Google Scholar 

  34. Rossi G, Pinto A, Pinto F et al (2000) Unreported CT findings in entire colon infarction: gas in the inferior mesenteric vein and in the parietal and visceral branches of the internal iliac veins. Radiol Med 99:107–109

    CAS  PubMed  Google Scholar 

  35. Kriegshauer JS, Reading CC, King BF, Welch TJ (1990) Combined systemic and portal venous gas: sonographic and CT detection in two cases. AJR Am J Roentgenol 154:1219–1221

    Article  Google Scholar 

  36. Frola C, Cantoni S, Turtulici I, Loria F (1994) Case report: bowel infarction with splenic air embolism: computed tomography findings. Br J Radiol 67:1272–1274

    Article  CAS  PubMed  Google Scholar 

  37. Faberman RS, Mayo-Smith WW (1997) Outcome of 17 patients with portal venous gas detected by CT. AJR Am J Roentgenol 169:1535–1538

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Monaldi Hospital, via Leonardo Bianchi, 80131, Naples, Italy

    Francesco Lassandro, Tullio Valente, Gaetano Rea & Giulia Lassandro

  2. Department of Health Sciences, Chair of Radiology, University of Molise, Località Tappino, 86100, Campobasso, Italy

    Luca Brunese

  3. Department of Radiological Sciences, Oncology and Pathology, “Sapienza” University of Rome, ICOT Hospital, via Franco Faggiana 34, 04100, Latina, Italy

    Andrea Laghi

  4. Department of Diagnostic Imaging, Pineta Grande Medical Center, Caserta, Italy

    Erica Golia

Authors
  1. Francesco Lassandro
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  2. Tullio Valente
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  3. Gaetano Rea
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  4. Giulia Lassandro
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  6. Luca Brunese
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  7. Andrea Laghi
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Correspondence to Francesco Lassandro.

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Lassandro, F., Valente, T., Rea, G. et al. Imaging assessment and clinical significance of pneumatosis in adult patients. Radiol med 120, 96–104 (2015). https://doi.org/10.1007/s11547-014-0461-5

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  • DOI: https://doi.org/10.1007/s11547-014-0461-5

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