47y/o female with abdominal pain and distention

Images

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation ::Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mirhadi Razavian

Case Section

Abdominal Imaging

Patient's Information

Gender : Male
Age : 47

Clinical Summary

47y/o female with abdominal pain and distention

Imaging Findings

On radiographs linear patern of gas and on CT low-density linear or bubbly pattern of gas in the bowel wall is seen

Differential Diagnosis

•Stool may mimic the appearance of pneumatosis on conventional radiographs
◦CT will show air in bowel wall on dependent surface in pneumatosis
◦Air in the lumen should rise to the highest non-dependent part of lumen

Final Diagnosis

pneumatosis intestinalis

Discussion (Related Text)

Intramural gas, also known as pneumatosis intestinalis, refers to gas within the wall of the bowel and although in some instances may be an incidental finding, it is often seen in the setting of intestinal ischaemia and infarction.Abdominal radiography and CT are the most frequently used techniques for diagnosis of PI. CT has been shown to be more sensitive than radiography at detecting PI. CT has also been shown to be more sensitive than radiography at detection of hepatic portal and portomesenteric venous gas ,the presence of which increases the possibility of PI due to life-threatening causes.Linear or bubble-like PI can be due to both benign and life-threatening causes, and its radiographic or CT appearance alone does not allow differentiation between them. In PI due to benign causes, the bowel wall is usually normal. The presence of additional findings such as bowel wall thickening, absent or intense mucosal enhancement, dilated bowel, arterial or venous occlusion, ascites, and hepatic portal or portomesenteric venous gas increases the possibility of PI due to a life-threatening cause .PI that is confined to a portion of the small or large bowel within a specific vascular distribution also increases the likelihood that ischemia is the cause of PI. Intraperitoneal or retroperitoneal free air can be seen with PI due to life-threatening or benign causes .Although the discovery of hepatic portal or portomesenteric venous gas helps to distinguish between benign and life-threatening causes of PI, it may also occur with or without PI as a result of nonischemic conditions. Mesenteric abscess formation, portomesenteric thrombophlebitis, sepsis, abdominal trauma, severe enteritis, cholangitis, chronic cholecystitis, pancreatitis, inflammatory bowel disease, and diverticulitis and after gastrointestinal surgery or liver transplantation are some of the various nonischemic clinical conditions that have been associated with hepatic portal and portomesenteric venous gas .Rarely, PI can also be seen on MRI. circumferential collections of air adherent to or within the wall that became more apparent on gradient-echo images due to blooming artifact associated with magnetic field inhomogeneities at air–tissue interfaces.Pulmonary causes of PI are usually benign and range from congenital to acquired. Cystic fibrosis, asthma, and chronic obstructive pulmonary disease have a well-known association with PI .Mesenteric ischemia is the most common life-threatening cause of PI .Occasionally, thromboembolization is proven as a cause of the ischemia , but often the exact cause is never established. Other life-threatening causes of PI include bowel obstruction, cecal ileus, toxic megacolon , and collagen vascular diseases (which may also produce PI due to benign causes). As described, PI in the setting of organ transplantation is often benign, but it can also be life threatening, especially after bone marrow transplantation. Acute graft-versus-host disease as a life-thr

References

• 1. Devos AS, Blickman JG, Blickman JG. Radiological Imaging of the Digestive Tract in Infants and Children. Springer Verlag. (2007) ISBN:3540407332. Read it at Google Books - Find it at Amazon
• 2. Pickhardt PJ, Kim DH, Taylor AJ. Asymptomatic pneumatosis at CT colonography: a benign self-limited imaging finding distinct from perforation. AJR Am J Roentgenol. 2008;190 (2): W112-7. doi:10.2214/AJR.07.2843 - Pubmed citation
• Citation: American Journal of Roentgenology. 2007;188: 1604-1613.