Portal-venous gas unrelated to mesenteric ischemia.
The aim of this study was to report on 8 patients with all different non-ischemic etiologies for portal-venous gas and to discuss this rare entity and its potentially misleading CT findings in context with a review of the literature. The CT examinations of eight patients who presented with intrahepatic portal-venous gas, unrelated to bowel ischemia or infarction, were reviewed and compared with their medical records with special emphasis on the pathogenesis and clinical impact of portal-venous gas caused by non-ischemic conditions. The etiologies for portal-venous gas included: abdominal trauma ( n=1); large gastric cancer ( n=1); prior gastroscopic biopsy ( n=1); prior hemicolectomy ( n=1); graft-vs-host reaction ( n=1); large paracolic abscess ( n=1); mesenteric recurrence of ovarian cancer superinfected with clostridium septicum ( n=1); and sepsis with Pseudomonas aeruginosa ( n=1). The clinical outcome of all patients was determined by their underlying disease and not negatively influenced by the presence of portal-venous gas. Although the presence of portal-venous gas usually raises the suspicion of bowel ischemia and/or intestinal necrosis, this CT finding may be related to a variety of non-ischemic etiologies and pathogeneses as well. The knowledge about these conditions may help to avoid misinterpretation of CT findings, inappropriate clinical uncertainty and unnecessary surgery in certain cases.
Wiesner
Walter
W
Department of Radiology, Brigham and Women's Hospital, Harvard Medic Petersgraben 4, 4031 Basel, Switzerland. wwiesner @uhbs.ch
Mortelé
Koenraad J
KJ
Glickman
Jonathan N
JN
Ji
Hoon
H
Ros
Pablo R
PR
D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects; D003015:Clostridium Infections / Q000000981:diagnostic imaging; D003082:Colectomy / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D005740:Gases; D006087:Graft vs Host Reaction; D006801:Humans; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000150:complications; D011169:Portal Vein; D011183:Postoperative Complications; D011552:Pseudomonas Infections / Q000000981:diagnostic imaging; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
D005740:Gases