Learning Radiology xray montage

Gastric Emphysema and Emphysematous Gastritis

Gastric Emphysema

  • Air in the stomach wall with an appearance similar to emphysematous gastritis with a much more benign clinical course
  • Caused by disruption in mucosa leading to air dissecting into wall from:
    • Gastric outlet obstruction with increased intraluminal pressure
    • Severe vomiting
    • Instrumentation-like endoscopy
    • Dissection of air from mediastinum from ruptured bleb or pneumothorax
    • Pneumatosis cystoides - submucosal air collections

    gastric emphysema

    Air in stomach wall outlines greater curvature of stomach

gastric emphysema

Air outlines the wall of the stomach on an axial scan of the upper abdomen.

Emphysematous gastritis

  • Rare and severe gastritis secondary to mucosal disruption and gas-forming bacterial invasion
  • Characterized by air in the wall of the stomach

  • Causes:

    • Ingestion of toxic material such as corrosives
    • Alcohol ingestion
    • Trauma
    • Gastric infarction
    • Ulcer disease
  • Submucosa is invaded by gas-forming organisms which include:
    • Hemolytic strep
    • Clostridia Welchi
    • E. Coli
    • Staph aureus

  • Clinical:

    • Sudden and violent onset of  bloody emesis
    • Fever
    • Nausea
    • Chills
    • Leukocytosis

  • Imaging

    • Linear small gas bubbles in gastric wall
      • Gastric emphysema is more linear, streak-like
    • Gas in portal vein

  • Prognosis:

    • 60-80% fatal
  • Best way to differentiate emphysematous gastritis from gastric emphysema:
    • Look at patient
      • Patients with gastric emphysema are a asymptomatic from the bowel gas air
      • Patients with emphysematous gastritis are usually deathly ill