Hepatic Portal Venous Gas and “The Aquarium Sign” Due to Intussusception in Kawasaki Disease

Abstract

The presence of hepatic portal venous gas (HPVG) may be secondary to bowel necrosis, mechanical distension, or intraabdominal sepsis. We describe an unusual and hitherto unreported presence of HPVG manifesting as gas embolization and the unique "aquarium sign" in a patient of Kawasaki's disease. Continuous passage of bubble-like echoes flowing from the hepatic portal venous system into the inferior vena cava and right-sided chambers of heart was noted on echocardiography. The patient was treated with intravenous immune-globulins and made an uneventful recovery.

The aquarium in the right heart

“…To our awareness, there has been only one published case report with similar gas embolization seen in the echocardiography in a pediatric patient with Kawasaki disease with intussusception and portovenous gas. The term “Aquarium sign” was used by Singh to describe the numerous microbubbles in the right atrium and ventricle …”

Hepatic portal venous gas in Crohn's disease

“…Abdominal ultrasound is also sensitive in detecting HPVG which may at times only be seen on ultrasonography. In relation to abdominal ultrasound the continuous passage of bubble-like echoes, flowing from the portal and intrahepatic portal radicles and inferior vena cava towards the cardiac chambers is akin to passage of bubbles in an aquarium and has prompted the term ‘aquarium sign’ 5 6…”