Portomesenteric venous gas: Is gas distribution linked to etiology and outcome?

Heye, Tobias; Bernhard, Michaël; Mehrabi, Arianeb; Kauczor, Hans‐Ulrich; Hosch, Waldemar

doi:10.1016/j.ejrad.2012.07.017

Cited by 19 publications

(23 citation statements)

References 21 publications

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“…Indeed, among the 69 patients with PI and PMVG in our study, 48 (69.6 %) had bowel ischemia. While Heye et al [1] reported that PMVG located in the arcade vessels was the best indicator for ischemia compared to other, more proximal, sites of PMVG, our study is the first to show a statistically significant correlation for any possible location except for gas located in the superior mesenteric vein. This latter result is likely a random finding and clinically insignificant, since PI and PMVG represent progressive steps in a single pathophysiological process.…”

Section: Discussionmentioning

confidence: 40%

“…The presence and extension of PMVG were classified, as described by Heye et al [1], into venous arcades, segmental mesenteric veins, the superior mesenteric vein, the extrahepatic portal vein, and the intrahepatic portal vein.…”

Section: Methodsmentioning

confidence: 99%

“…PI may involve any part of the digestive tract. It can occur with gas in the portal or mesenteric veins [1, 2]. PI was first described as early as 1730 by Duvernoy during a cadaveric dissection [3], while portomesenteric venous gas (PMVG) was initially reported by Wolf and Evans in 1955 [4].…”

Section: Introductionmentioning

confidence: 99%

“…The detection of PI had historically been considered an alarming radiological feature, since it was almost always interpreted as acute bowel ischemia, thus necessitating immediate surgery [5, 6]. The patient’s situation is even more critical whenever PMVG is present [1, 2, 7]. …”

Section: Introductionmentioning

confidence: 99%

“…Finally, PI can also occur with chronic obstructive pulmonary disease, or it may result from artificial ventilation with positive end-expiratory pressure, thus representing an incidental finding on MDCT without any need for treatment [1, 19, 20]. This so-called “pulmonary theory” has been explained by disruption of alveoli, followed by extension of gas through the mediastinum along the tissue planes and through the perivascular spaces into the bowel wall; however, definite proof is lacking [5, 9].…”

Section: Introductionmentioning

confidence: 99%

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Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

et al. 2016

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ObjectivesTo evaluate the clinical significance of pneumatosis intestinalis (PI) including the influence on treatment and outcome.Method and MaterialsTwo radiologists jointly reviewed MDCT-examinations of 149 consecutive emergency patients (53 women, mean age 64, range 21-95) with PI of the stomach (n = 4), small (n = 68) and/or large bowel (n = 96). PI extension, distribution and possibly associated porto-mesenteric venous gas (PMVG) were correlated with other MDCT-findings, risk factors, clinical management, laboratory, histopathology, final diagnosis and outcome.ResultsThe most frequent cause of PI was intestinal ischemia (n = 80,53.7 %), followed by infection (n = 18,12.1 %), obstructive (n = 12,8.1 %) and non-obstructive (n = 10,6.7 %) bowel dilatation, unknown aetiologies (n = 8,5.4 %), drugs (n = 8,5.4 %), inflammation (n = 7,4.7 %), and others (n = 6,4 %). Neither PI distribution nor extension significantly correlated with underlying ischemia. Overall mortality was 41.6 % (n = 62), mostly related to intestinal ischemia (p = 0.003). Associated PMVG significantly correlated with underlying ischemia (p = 0.009), as did the anatomical distribution of PMVG (p = 0.015). Decreased mural contrast-enhancement was the only other MDCT-feature significantly associated with ischemia (p p < 0.001). Elevated white blood count significantly correlated with ischemia (p = 0.03).ConclusionIn emergency patients, ischemia remains the most common aetiology of PI, showing the highest mortality. PI with associated PMVG is an alerting sign. PI together with decreased mural contrast-enhancement indicates underlying ischemia.Key Points• In emergency patients, PI may be caused by various disorders.• Intestinal ischemia remains the most common cause of PI in acute situations.• PI associated with decreased mural contrast-enhancement indicates acute intestinal ischemia.• PI associated with PMVG should alert the radiologist to possible underlying ischemia.

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Section: Discussionmentioning

confidence: 40%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

et al. 2016

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

Lim

Jung

2022

J of Ultrasound Medicine

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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.

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G

Paolantonio¹,

Dromain

2013

A-Z Notes in Radiological Practice and Reporting

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Portomesenteric venous gas: Is gas distribution linked to etiology and outcome?

Cited by 19 publications

References 21 publications

Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

Clinical significance of pneumatosis intestinalis – correlation of MDCT-findings with treatment and outcome

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

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