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Pneumatosis Intestinalis and Portomesenteric Venous Gas in Intestinal Ischemia

Correlation of CT Findings with Severity of Ischemia and Clinical Outcome

Walter Wiesner1,2, Koenraad J. Mortelé1, Jonathan N. Glickman3, Hoon Ji1 and Pablo R. Ros1

1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
2 Present address: Institute of Diagnostic Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
3 Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.



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  		Fig. 1A. —58-year-old woman with transmural infarction of distal colon. Unenhanced CT scan shows intrahepatic portal venous gas in left liver lobe.

 


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  		Fig. 1B. —58-year-old woman with transmural infarction of distal colon. Unenhanced CT scan shows marked wall thickening of infarcted colon (arrows). Note absence of pneumatosis. Patient survived.

 


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  		Fig. 2. —80-year-old woman with only partial mural small-bowel ischemia. Contrast-enhanced CT scan shows bubblelike pneumatosis (arrow) and bandlike pneumatosis (arrowhead) in proximal small bowel and pronounced mesenteric venous gas. Patient survived.

 


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  		Fig. 3. —64-year-old man with transmural small-bowel infarction. Unenhanced CT scan shows bubblelike pneumatosis in small bowel (arrows), but no mesenteric venous gas. Patient survived.

 


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  		Fig. 4. —82-year-old man with only partial mural ischemia of cecum and ascending colon. Unenhanced CT scan shows bubblelike pneumatosis of ascending colon (arrows), but no mesenteric venous gas. Patient survived.

 


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  		Fig. 5. —53-year-old man with transmural colonic infarction. Unenhanced CT scan shows bandlike pneumatosis of ascending and transverse colon (arrows), but no portomesenteric venous gas. Patient survived.

 


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  		Fig. 6. —63-year-old man with extended transmural infarction of small and large bowel. Contrast-enhanced CT scan shows bandlike pneumatosis of multiple small-bowel loops and colon and mesenteric venous gas (arrow). Patient died.

 

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