|
|
Portal Venous Gas
General Considerations
- Initially associated with bowel necrosis and death, portal venous gas is now being imaged in many benign conditions
- Pathophysiologically, thought to be due to some combination of
- Damage to mucosa
- Intra-abdominal sepsis
- Frequently associated with gas in the bowel wall (pneumatosis intestinalis) when due to necrotic bowel
Clinical Findings
Imaging Findings
- Can be diagnosed on conventional radiography, CT or ultrasound
- Branching, air-containing structures near or at the periphery of the liver
- From centrifugal flow of blood in portal vein
- More air accumulates in left portal vein as it is more anterior, but air is seen more easily on plain films in right lobe of liver
- Thinner lucencies than air in branches of biliary tree (pneumobilia)
- Air in biliary system is more central and branches are far fewer in number
- Ultrasound shows bright, echogenic foci in the periphery of the liver with centrifugal flow
Differential Diagnosis
- Air in the biliary tree (see above)
Treatment
- Surgery is usually performed for ischemic bowel disease especially for those with signs of perforation, sepsis or peritonitis
Prognosis
- With bowel necrosis, mortality remains high (45-65%)
- Without bowel necrosis, may spontaneously and quickly resolve without significant mortality
 
Portal Venous Gas. There is a small bowel obstruction with dilated loops of small bowel and gas
in the bowel wall (red circle). There are also black, branching structures at the periphery of the liver seen
in the blue circles on the left and in the close-up on the right. This is the appearance of portal venous gas.
For more information, click on the link if you see this icon
For this same photo without the annotations, click here and here
Hepatic portal venous gas: transient radiographic finding associated with colchicine toxicity. Saksena, M; Harisinghani, M; Wittenberg, J and Mueller, P. British Journal of Radiology (2003) 76, 835-837
Portal venous Gas. Radiopedia. D’Souza, D
|
|
|
){kind=link}
