Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Case 50 Simulated active bleeding
- Case 51 Pseudopneumoperitoneum
- Case 52 Intra-abdominal focal fat infarction: epiploic appendagitis and omental infarction
- Case 53 False-negative and False-positive FAST
- Liver and biliary
- Spleen
- Pancreas
- Bowel
- Case 61 Pseudothickening of the bowel wall
- Case 62 Small bowel transient intussusception
- Case 63 Duodenal diverticulum
- Case 64 Pseudopneumatosis
- Case 65 Pneumatosis intestinalis
- Case 66 Pseudoappendicitis
- Kidney and ureter
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Case 64 - Pseudopneumatosis
from Bowel
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgments
- Section 1 Brain, head, and neck
- Section 2 Spine
- Section 3 Thorax
- Section 4 Cardiovascular
- Section 5 Abdomen
- Case 50 Simulated active bleeding
- Case 51 Pseudopneumoperitoneum
- Case 52 Intra-abdominal focal fat infarction: epiploic appendagitis and omental infarction
- Case 53 False-negative and False-positive FAST
- Liver and biliary
- Spleen
- Pancreas
- Bowel
- Case 61 Pseudothickening of the bowel wall
- Case 62 Small bowel transient intussusception
- Case 63 Duodenal diverticulum
- Case 64 Pseudopneumatosis
- Case 65 Pneumatosis intestinalis
- Case 66 Pseudoappendicitis
- Kidney and ureter
- Section 6 Pelvis
- Section 7 Musculoskeletal
- Section 8 Pediatrics
- Index
- References
Summary
Imaging description
Pneumatosis intestinalis (PI) refers to the presence of gas within the wall of the bowel. Pneumatosis intestinalis can be “benign” or life-threatening (Figure 64.1). CT is more sensitive than radiographs for the detection of PI, although the identification of this finding does not mandate surgery [1].
Pseudopneumatosis may resemble PI, but it occurs when intraluminal gas is trapped against the bowel mucosa not within the bowel wall (Figure 64.2). This may occur between mucosal folds, between the mucosa and viscous bowel contents (Figure 64.3), or when bubbles adhere to the mucosa of the bowel. Pseudopneumatosis most commonly occurs in the cecum and ascending colon (Figure 64.4) [2].
Pseudopneumatosis may resemble PI, but it occurs when intraluminal gas is trapped against the bowel mucosa not within the bowel wall (Figure 64.2). This may occur between mucosal folds, between the mucosa and viscous bowel contents (Figure 64.3), or when bubbles adhere to the mucosa of the bowel. Pseudopneumatosis most commonly occurs in the cecum and ascending colon (Figure 64.4) [2].
Importance
The importance of not mistaking pseudopneumatosis for PI is that life-threatening causes of PI, such as mesenteric ischemia, toxic megacolon, acute graft-versus-host diseases, bowel obstruction, and cecal ileus should be considered whenever pneumatosis is identified [3]. The presence of portomesenteric gas and PI is suggestive but not diagnostic of transmural bowel infarction [1, 4]. However, a very large number of “benign” causes have been identified [3]. These are covered more completely in Case 65 and include pulmonary diseases such as obstructive airway disease, cystic fibrosis, and lung transplantation, iatrogenic causes such as placement of percutaneous feeding tubes (Figure 64.5), endoscopic procedures, and corticosteroid administration [3]. Clinical predictors, such as the presence of abdominal distension, peritonitis, and lactic acidemia are most predicative of positive intraoperative findings [5].
- Type
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- Pearls and Pitfalls in Emergency RadiologyVariants and Other Difficult Diagnoses, pp. 210 - 212Publisher: Cambridge University PressPrint publication year: 2013