title: Echography of the Portal Vein in a Patient With Shock.
abstract: OBJECTIVE
  To report the utility of abdominal ultrasonography to identify portal venous gas in patients with shock, as an indicator of acute mesenteric ischemia, and to illustrate the aspect of portal venous gas on ultrasonography.
  
  
  METHODS
  Clinical observation of a patient, images of abdominal ultrasonography and abdominal computed tomography, and video of portal venous gas.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Relevant information contained in the medical observation of the patient and selection of image and video of ultrasonography performed in the patient.
  
  
  RESULTS
  We report a case of nonocclusive mesenteric ischemia in a 76-year-old patient following cardiac surgery. The diagnosis of acute mesenteric ischemia was proposed based on evidence of portal venous gas on abdominal ultrasonography and then confirmed by abdominal computed tomography showing transverse colonic ischemia, the presence of gas in the mesenteric veins but not in the portal vein. Urgent laparotomy confirmed extensive nonocclusive mesenteric ischemia, and the patient rapidly died of multiple organ failure.
  
  
  CONCLUSIONS
  Intensive care physicians should be aware of the ultrasound characteristics of portal venous gas. In patients with shock, in addition to cardiac and thoracic echography, investigation of portal venous gas using bedside ultrasonography may help the clinician to identify patients in whom acute mesenteric ischemia develops.
authors.affiliation: 1Medical Intensive Care Unit, Besançon University Hospital, Besançon, France. 2Research Unit EA3920 and SFR FED 4234, University of Franche Comté, Besançon, France. 3Department of Epidemiology and Preventive Medicine, Adjunct Professor, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia. 4Radiology Unit, Besançon University Hospital, Besançon, France.
authors.forename: Gaël
authors.initials: G
authors.lastname: Piton
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
authors.forename: Eric
authors.initials: E
authors.lastname: Delabrousse
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D011169:Portal Vein / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D012769:Shock / Q000000981:diagnostic imaging* / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography