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Asymptomatic Pneumatosis at CT Colonography: A Benign Self-Limited Imaging Finding Distinct from Perforation

Perry J. Pickhardt1,2, David H. Kim1 and Andrew J. Taylor1

1 Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252.
2 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD.


Figure 1
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  		Fig. 1A —Screening CT colonography in asymptomatic 54-year-old man. Supine transverse (A) and coronal (B) 2D images with polyp window settings (width, 2,000 H; level, 0 H) show thin curvilinear pneumatosis involving ascending colon and ileocecal valve (arrow, B). Less than half of short-axis circumference was involved in this case. Patient remained asymptomatic immediately after procedure and has developed no new symptoms in 13 months since study.

 

Figure 2
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  		Fig. 1B —Screening CT colonography in asymptomatic 54-year-old man. Supine transverse (A) and coronal (B) 2D images with polyp window settings (width, 2,000 H; level, 0 H) show thin curvilinear pneumatosis involving ascending colon and ileocecal valve (arrow, B). Less than half of short-axis circumference was involved in this case. Patient remained asymptomatic immediately after procedure and has developed no new symptoms in 13 months since study.

 

Figure 3
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  		Fig. 2 —Diagnostic CT colonography in asymptomatic 64-year-old woman with history of incomplete optical colonoscopy 7 months earlier. Supine transverse 2D image shows thin curvilinear right-sided colonic pneumatosis. Patient did not develop any symptoms immediately after procedure or in 30 months since examination.

 

Figure 4
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  		Fig. 3A —Diagnostic CT colonography in 30-year-old woman with history of persistent abdominal pain and diarrhea. Transverse (A) and coronal (B) 2D images show uniformly thin pneumatosis involving entire cecum and ascending colon. This was the extensive case of right-sided pneumatosis in our series.

 

Figure 5
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  		Fig. 3B —Diagnostic CT colonography in 30-year-old woman with history of persistent abdominal pain and diarrhea. Transverse (A) and coronal (B) 2D images show uniformly thin pneumatosis involving entire cecum and ascending colon. This was the extensive case of right-sided pneumatosis in our series.

 

Figure 6
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  		Fig. 3C —Diagnostic CT colonography in 30-year-old woman with history of persistent abdominal pain and diarrhea. Right-sided colonic pneumatosis is readily apparent on scout view.

 

Figure 7
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  		Fig. 4A —Screening CT colonography in asymptomatic 67-year-old man. Supine transverse 2D images show extensive left-sided (A) and limited right-sided (arrow, B) colonic pneumatosis. Macrocystic left-sided pneumatosis had typical appearance and distribution of benign pneumatosis cystoides coli, whereas separate right-sided findings resembled other cases in this series.

 

Figure 8
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  		Fig. 4B —Screening CT colonography in asymptomatic 67-year-old man. Supine transverse 2D images show extensive left-sided (A) and limited right-sided (arrow, B) colonic pneumatosis. Macrocystic left-sided pneumatosis had typical appearance and distribution of benign pneumatosis cystoides coli, whereas separate right-sided findings resembled other cases in this series.

 

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