Portal Vein Gas in Neonates: Predicting Clinical Treatment Outcomes From Ultrasound Findings

Abstract

Objectives-To identify sonographic findings that predict clinical outcomes in neonates with portal vein gas.Methods-This retrospective study included neonates with portal vein gas detected using ultrasound (US). The US images were reviewed by a pediatric radiologist. US findings included the extent and amount of portal vein gas, mesenteric vein gas, intramural gas, bowel wall thickening or thinning, focal discontinuity of the bowel wall, ascites, free intra-abdominal gas, pseudocyst, gas in the other solid organs, and bowel distension. The imaging findings and demographic factors between survivors and non-survivors were statistically compared.Results-The mortality rate was 26% (39 survivors, 14 non-survivors) when iatrogenic and idiopathic causes were excluded. The causes of portal vein gas were determined to be necrotizing enterocolitis (n = 33), bowel distension or obstruction (n = 12), fetal hydrops (n = 4), pneumothorax (n = 3), immediate postoperative state for bowel perforation (n = 1), and umbilical vein catheterization (n = 9) based on surgical findings (n = 20) and clinical information (n = 46). Gas within the mesenteric vein and the other solid organs, gestational age, and birth weight were significantly different between survivors and those who succumbed (P < .05).Conclusion-Gas within the mesenteric vein and other solid organs is a US finding that may predict poor outcomes in neonates with portal vein gas.

Association between the dynamic movement of hyperechoic foci and patients'/sonographic outcomes among pediatric patients with portal venous gas following a cardiac event

“…According to several previous studies, 20,21,31 hyperechoic foci in the liver in PVG manifest in the following sequence (Table 1): (1) they originate from the damaged intestine; (2) run within the mesenteric vein (including the splenic, superior mesenteric, or inferior mesenteric vein); (3) flow into the extra‐hepatic portal vein; (4) run into the intrahepatic and peripheral portal vein; (5) reach the liver parenchyma; (6) the PVG is absorbed. PVG observed on ultrasound usually corresponds to Steps 4, 5, and 6.…”

“…According to several previous studies, 20,21,31 hyperechoic foci in the liver in PVG manifest in the following sequence (Table 1): ( 1 The interval between the day of first PVG detection and the day of PVG diminishment on ultrasonography was recorded for each patient.…”

Letter to the Editor on “Portal Vein Gas in Neonates Predicting Clinical Treatment Outcomes From Ultrasound Findings”

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To the Editor: We have read with great interest the article by Lim et al, titled "Portal vein gas in neonates predicting clinical treatment outcomes from ultrasound findings." 1 Portal vein gas (PVG) is not a disease, but a diagnostic clue in patients who may be harboring an intra-abdominal abnormal condition. It represents a challenge for diagnosis and management of the underlying cause.

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