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Bitar R, Kaur M, Crandall I, McNamara R, Revzin MV. Ultrasound evaluation of portal venous gas and its mimics. Abdom Radiol (NY) 2024:10.1007/s00261-024-04328-2. [PMID: 38735019 DOI: 10.1007/s00261-024-04328-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024]
Abstract
Portal venous gas on abdominal ultrasound classically represents an indirect indicator of bowel ischemia, a critical condition which poses a high patient mortality and therefore warrants emergent corrective action. While the classic appearance of portal venous gas on ultrasound is well-described in the literature, the characteristic descriptors are nonspecific and may actually represent other less emergent mimics. Therefore, while radiologists should remain vigilant for the detection of findings corresponding to portal venous gas, they should also be aware of similar-appearing entities in order to provide the most accurate diagnosis. This pictorial essay will open with imaging examples of true portal venous gas attributable to bowel ischemia and describe the classic features which should alert radiologists to this specific diagnosis. Subsequently, this pictorial essay will provide imaging examples of other various other clinical entities which on ultrasound may share similar imaging characteristics. An important objective of this pictorial essay is to highlight distinguishing imaging features along with specific clinical circumstances for each pathological entity which can direct radiologists into identifying the correct diagnosis.
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Affiliation(s)
- Ryan Bitar
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Manroop Kaur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ian Crandall
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Robert McNamara
- Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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2
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López-González R, Sánchez-Cordero S, Ramos-Bouguerne K. Gas in the portomesenteric venous system secondary to intraabdominal infectious condition. Med Clin (Barc) 2024:S0025-7753(24)00190-8. [PMID: 38688734 DOI: 10.1016/j.medcli.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Ruth López-González
- Servicio de Cirugía General y Digestiva, Hospital Universitario Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - Sergi Sánchez-Cordero
- Servicio de Cirugía General y Digestiva, Hospital Universitario Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - Karim Ramos-Bouguerne
- Servicio de Digestología, Hospital Universitario Moisès Broggi, Sant Joan Despí, Barcelona, España
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3
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Liu A, Shen J, Long L, Shi X, Wen Q, Pan Z. Hepatic portal venous gas initially manifesting as severe shock: a case series. J Int Med Res 2024; 52:3000605241239469. [PMID: 38603615 PMCID: PMC11010767 DOI: 10.1177/03000605241239469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/28/2024] [Indexed: 04/13/2024] Open
Abstract
Hepatic portal venous gas is often referred to as the "sign of death" because it signifies a very poor prognosis if appropriate treatments are not promptly administered. The etiologies of hepatic portal venous gas are diverse and include severe complex abdominal infections, mesenteric ischemia, diving, and complications of endoscopic surgery, and the clinical manifestations are inconsistent among individual patients. Thus, whether emergency surgery should be performed remains controversial. In this report, we present three cases of hepatic portal venous gas. The patients initially exhibited symptoms consistent with severe shock of unknown etiology and were treated in the intensive care unit upon admission. We rapidly identified the cause of each individual patient's condition and selected problem-directed intervention measures based on active organ support, antishock support, and anti-infection treatments. Two patients recovered and were discharged without sequelae, whereas one patient died of refractory infection and multiple organ failure. We hope that this report will serve as a valuable reference for decision-making when critical care physicians encounter similar patients.
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Affiliation(s)
- Anwei Liu
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Jiao Shen
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Liansheng Long
- Department of General Surgery, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Xuezhi Shi
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Qiang Wen
- Department of Intensive Care Unit, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
| | - Zhiguo Pan
- Emergency Department, the General Hospital of Southern Theater Command, the Chinese People’s Liberation Army, Guangzhou, China
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4
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Hsu TY, Hsieh CC, Yu CJ, Chiu WC. An elderly woman with acute abdominal pain. Asian J Surg 2024; 47:1622-1623. [PMID: 38195277 DOI: 10.1016/j.asjsur.2023.12.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Affiliation(s)
- Tien-You Hsu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-Chieh Hsieh
- Department of Biomedical Engineering, National Taiwan University, Taiwan; Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Emergency Medicine, Ten-Chan General Hospital, Chung-Li, Taoyuan, Taiwan
| | - Ching-Juing Yu
- Department of Emergency Medicine, Ten-Chan General Hospital, Chung-Li, Taoyuan, Taiwan
| | - Wei-Che Chiu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Arico FM, Buemi F, Pitrone P, Giardina C, Trimarchi R, Borruto F, Doria S, Turiaco C, Caloggero S. Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon. Diagnostics (Basel) 2023; 13:3615. [PMID: 38132200 PMCID: PMC10742429 DOI: 10.3390/diagnostics13243615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.
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Affiliation(s)
- Francesco M. Arico
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Francesco Buemi
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Pietro Pitrone
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | | | - Renato Trimarchi
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Department of Radiology, ASST Bergamo Ovest, Ospedale Treviglio-Caravaggio, 24047 Treviglio, BG, Italy
| | - Flavia Borruto
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Sarah Doria
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
| | - Cristina Turiaco
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Hospital “Policlinico G. Martino”, 98124 Messina, ME, Italy
- Radiology Unit, “Papardo” Hospital, 98158 Messina, ME, Italy
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Zhang Q, Meng H, Chen Y, Meng F. Bezoar as a cause of portal vein pneumatosis: a case report. J Int Med Res 2023; 51:3000605231180540. [PMID: 37377054 DOI: 10.1177/03000605231180540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Pneumatosis of the portal vein is considered a rare imaging sign rather than a disease. It usually occurs in patients with digestive tract diseases such as intestinal obstructive diseases, mesenteric vascular diseases, closed abdominal trauma, and liver transplantation. Because of its high mortality rate, it is also termed the "sign of death." Hawthorn contains tannic acid, and seafood is rich in calcium, iron, carbon, iodine, and other minerals and proteins. Thus, consuming both hawthorn and seafood together can result in the formation of an indigestible complex in the body, acting as the main pathogenic factor in patients with intestinal obstruction. We herein describe a patient with duodenal obstruction caused by hawthorn who developed the hepatic portal venous gas sign and was cured by nonsurgical treatment.
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Affiliation(s)
- Qing Zhang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Heyu Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Yanqiu Chen
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
| | - Fanbo Meng
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
- Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Changchun, Jilin 130033, China
- Jilin Provincial Molecular Biology Research Center for Precision Medicine of Major Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin 130033, China
- Jilin Provincial Precision Medicine Key Laboratory for Cardiovascular Genetic Diagnosis, Changchun, Jilin 130033, China
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Abstract
Acute mesenteric ischemia (AMI) is an uncommon yet highly lethal cause of acute abdomen in the emergency setting. Computed tomography (CT) imaging, in particular a biphasic protocol consisting of angiographic and venous phase scans, is widely used to corroborate non-specific clinical findings when suspicions of AMI are high. Techniques such as low kilovoltage peak scanning, dual energy acquisition, or a combined arterial/enteric phase can improve iodine conspicuity and evaluation of bowel enhancement. Biphasic CT with CT angiography is mandatory to directly assess for the 3 primary etiologies of AMI-arterial, venous, and non-occlusive mesenteric ischemia (NOMI), and the CT angiographic findings may be the first visible in the disease. In addition, numerous non-vascular CT findings have also been reported. Bowel wall thickening, mesenteric stranding, and ascites are common but non-specific findings that correlate poorly with disease severity. Pneumatosis intestinalis and portomesenteric venous gas, while not pathognomonic for ischemia, are highly specific in cases of high clinical suspicion. Bowel wall hypoenhancement is an early and specific sign but requires a protocol optimizing iodine conspicuity to confidently identify. Finally, intraperitoneal free air and solid organ infarcts are also highly specific ancillary findings in AMI. AMI occurs as a complication in 10% of small bowel obstruction (SBO) patients, and understanding imaging findings of ischemia in the context of SBO is necessary to aid in treatment planning and reduce over- and under-diagnosis of strangulation. Familiarity with the imaging features of ischemia by radiologists is vital to establish an early diagnosis before irreversible necrosis occurs.
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Affiliation(s)
- Hang Yu
- Department of Diagnostic Radiology, 8664University of Manitoba, Winnipeg, MB, Canada
| | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, 8664University of Manitoba, Winnipeg, MB, Canada
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Furtado T, Domingues P, Piedade A, Parreira L, Natário A. A Rare and Severe Cause of Abdominal Pain in a Hemodialysis Patient. Cureus 2022; 14:e30800. [DOI: 10.7759/cureus.30800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
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White spirit poisoning: An unusual cause of hepatic portal venous gas. Radiol Case Rep 2022; 17:4717-4722. [PMID: 36212755 PMCID: PMC9535280 DOI: 10.1016/j.radcr.2022.08.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
Abstract
Traditionally, the presence of air within the hepatic portal venous system has been considered a rather ominous sign as it has been associated with conditions of increased associated morbidity and mortality such as bowel ischemia and intraabdominal sepsis. However, benign conditions, not requiring any particular intervention, have been implemented in the etiology, as well. In the present report, we present the case of the accidental ingestion of white spirit as a rather unusual cause of hepatic portal vein gas. A 32-year-old, otherwise healthy, male was admitted to the emergency department following the accidental ingestion of a “sip,” approximately 15 ml, of white spirit. The patient was complaining of nausea and upper abdominal pain that started soon after the ingestion of caustic agent. An imaging investigation with a computed tomography scan (CT) of the abdomen revealed the presence of hepatic portal vein gas along with a diffuse edema of the gastric wall at the site of the lesser curvature. A follow-up CT, 2 days after the admission, revealed no evidence of hepatic portal venous gas. Based on the patient's good general condition, an expectant management was decided. No intervention was required, oral feeding was recommenced after 6 days of fasting and the patient was discharged 8 days after the admission. Hepatic portal venous gas is a very impressive imaging finding with remarkably diverse etiology and prognostic correspondence. Irrespective of the cause, an approach of managing patients with hepatic portal venous gas according to their clinical condition appears reasonable.
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Lim YJ, Jung HK. Portal Vein Gas in Neonates: Predicting Clinical Treatment Outcomes From Ultrasound Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2557-2566. [PMID: 35040498 DOI: 10.1002/jum.15945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
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.
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Affiliation(s)
- Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Hyun Kyung Jung
- Department of Radiology, Haeundae Paik Hospital, Inje University, Busan, Korea
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11
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Dong X, You S, Zhang H, Wang D, Pan W, Zhang B, Huang S, Li X, Pang J, Ji W. Venous gas caused by emphysematous pyelonephritis: a case report and review of literature. BMC Urol 2022; 22:154. [PMID: 36123660 PMCID: PMC9487055 DOI: 10.1186/s12894-022-01104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emphysematous pyelonephritis (EPN) is a potentially life-threatening disease caused by a gas-producing necrotizing bacterial infection that involves the renal parenchyma, collecting system, and/or perinephric tissue. EPN is often complicated by a previous diagnosis of diabetes mellitus, and venous air bubbles are an uncommon complication of it. We describe a 52-year-old woman who was admitted in coma, with a history of vomiting, and was found to have EPN with air bubbles in the uterine veins. We discuss the presentation, diagnosis, and pathogenesis of this uncommon but clinically significant event, and briefly review other case reports of venous gas or thrombosis caused by EPN. CASE PRESENTATION We report the case of a 52-year-old woman with past history of type 2 diabetes mellitus, presenting with loss of consciousness after vomiting for half a day. Abdominal computed tomography scan revealed unilateral EPN with air bubbles in the uterine veins. The blood, pus, and urine cultures were positive for extended-spectrum beta-lactamase-producing Escherichia coli. The patient's condition improved well after conservative management comprising supportive measures, broad-spectrum antibiotics, percutaneous drainage therapy, and an open operation. CONCLUSIONS Venous air bubbles are rare but fatal complication of EPN. Early diagnosis and treatment are critical to ensure good results.
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Affiliation(s)
- Xue Dong
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Shuzong You
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Huangqi Zhang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Dongnv Wang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Wenting Pan
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Binhao Zhang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Shanqiang Huang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Xin Li
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Jianxin Pang
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China
| | - Wenbin Ji
- Department of Radiology, Taizhou Hospital, Zhejiang University, Taizhou, 318000, Zhejiang, China.
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Giulio F, Ruggiero S, Vicini S, Bellini D, Rengo M, Carbone I. Unusual computed tomography findings of gas in the superior mesenteric artery system with no signs of porto-mesenteric venous gas in a case of acute mesenteric ischemia. Radiol Case Rep 2022; 17:2568-2572. [PMID: 35634014 PMCID: PMC9130093 DOI: 10.1016/j.radcr.2022.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Acute Mesenteric Ischemia (AMI) is a rare life-threatening entity caused by sudden interruption of the blood supply to a segment of the bowel due to impairment of mesenteric arterial blood flow or venous drainage. Clinical presentation varies according to the time course of vascular occlusion. Contrast-enhanced Computed Tomography (CT) of the abdomen represents the main diagnostic test for AMI diagnosis, enabling fast and excellent evaluation of the intestine, mesenteric vasculature, and other ancillary characteristics of AMI. Typical CT findings of AMI include paralytic ileus, decreased or absent bowel wall contrast-enhancement, pneumatosis intestinalis, and porto-mesenteric venous gas. We hereby report a case of an 89-year-old man presenting with AMI due to Superior Mesenteric Artery (SMA) thrombotic occlusion following endovascular stenting superficial femoral arteries. Typical findings were observed on abdominal CT imaging, yet associated with the presence of gas exclusively in the SMA district, without any involvement of the porto-mesenteric venous system. Different imaging features and pitfalls can help radiologists to accurately diagnose AMI, especially when irreversible bowel damage is about to occur. Therefore, radiologists and emergency physicians should be aware of the unusual association between gas in the SMA arterial district and AMI, even in the absence of porto-mesenteric venous system involvement, in order to urge prompt surgical consultation when observed.
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Hwee Hong Lee A, Tellambura S. Pneumatosis intestinalis: Not always bowel ischemia. Radiol Case Rep 2022; 17:1305-1308. [PMID: 35242257 PMCID: PMC8857577 DOI: 10.1016/j.radcr.2022.01.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022] Open
Abstract
Pneumatosis intestinalis or abnormal intramural gas within the digestive tract usually suggests bowel ischemia necessitating urgent surgery. We report the case of an 82-year-old female presenting with hypotension and nausea, with a past history of schizophrenia, low grade chronic lymphocytic leukemia, stroke, bronchitis and rheumatoid arthritis. Computed tomography performed demonstrated extensive submucosal gas within the entire small bowel, associated with free gas in the peritoneal cavity. Bowel ischemia was diagnosed radiologically. However, a benign diagnosis of fecal impaction was ultimately made due to the patient's stable clinical status. Clinical correlation and close monitoring of clinical status in this context is of greatest diagnostic assistance when encountered with this phenomenon, to prevent unnecessary harm to the patient.
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Affiliation(s)
- Adele Hwee Hong Lee
- Department of General Surgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
- Corresponding author. A. Lee.
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14
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Karabulut UE, Gultekin MA, Sari L, Kılınc YB. A Case of Intratumoral and Hepatic Portal Venous Gas in Patient with Gastric Cancer Liver Metastases. Curr Med Imaging 2021; 18:263-265. [PMID: 34666645 DOI: 10.2174/1573405617666211018112041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hepatic portal venous gas [HPVG] is not a common finding in daily practice. It is usually associated with mesenteric ischemia and bowel necrosis in adults. Combination of intratumoral gas in metastatic liver lesions with HPVG is quite rare and thought to be associated with chemotherapy-induced necrosis and infection of the necrotized metastasis. OBJECTIVE Here we present a case of gastric adenocarcinoma with portal venous and intratumoral gas in metastatic liver lesions due to the infected necrosis. CASE PRESENTATION The patient was presented to the emergency room with severe abdominal pain and septic condition after the second round of chemotherapy. Hepatic portal venous and intratumoral gas in metastatic liver lesions due to the infected necrosis of liver metastasis was detected in computed tomography images. There were no findings of mesenteric ischemia both clinically and radiologically. Massive intratumoral infected necrosis in metastatic liver lesions and fistulization to the right portal vein branches were detected on abdominopelvic CT. Secondary infection of the necrotic metastases and fistulization to portal vein branches was believed to cause the air in metastatic liver masses and portal venous gas. CONCLUSION Infected necrosis of metastatic liver lesions and fistulizations to the portal venous structures is extremely rare. Clinicians and radiologists should be aware of such a rare complication because early detection is crucial for patient management.
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Affiliation(s)
- Ummuhan Ebru Karabulut
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul. Turkey
| | - Mehmet Ali Gultekin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul. Turkey
| | - Lutfullah Sari
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul. Turkey
| | - Yagmur Basak Kılınc
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul. Turkey
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15
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Rohith G, Rajesh BS, Archana E, Srinivasan K. Hydrogen Peroxide Poisoning-A Rare Cause of Portal Venous Gas. Indian J Radiol Imaging 2021; 31:492-494. [PMID: 34556938 PMCID: PMC8448209 DOI: 10.1055/s-0041-1734354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hydrogen peroxide is a clear and odorless liquid at room temperature that can easily be mistaken for water. Its ingestion results in varied clinical and radiological squeals depending on the volume and concentration of the liquid. We present a case of a 22-year-old lady who accidentally ingested 30 to 40 mL of 3% hydrogen peroxide and presented with hematemesis and abdominal pain. On further radiological evaluation, she was found to have portal venous gas and pneumatosis of the bowel wall. She was conservatively managed with 100% oxygen and nil per os for 2 days following which the portal venous gas resolved. Hydrogen peroxide ingestion causes a massive release of oxygen and when its volume exceeds its solubility in blood, gas embolism occurs that is responsible for portal venous gas and pneumatosis. Close monitoring with conservative management will suffice in mild cases without the need for any therapeutic intervention.
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Affiliation(s)
- Gorrepati Rohith
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - B S Rajesh
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Elangovan Archana
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - K Srinivasan
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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16
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Lebert P, Ernst O, Zins M, Lanchou M, Nzamushe JR, Vermersch M. Pneumatosis intestinalis and portal venous gas in mechanical small bowel obstruction: Is it worrisome? Diagn Interv Imaging 2021; 102:545-551. [PMID: 34030989 DOI: 10.1016/j.diii.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical significance of pneumatosis intestinalis (PI) and portal venous gas (PVG) in patients with mechanical small bowel obstruction (SBO), using surgical findings or clinical follow-up as standard of reference. MATERIALS AND METHODS Fourteen patients with mechanical SBO associated with PI and PVG were retrospectively included. There were 7 men and 7 women with a mean age of 59±19 (SD) (range: 25-93 years). CT examinations were reviewed by two radiologists to confirm the diagnosis of mechanical SBO and make a description of PI. Interobserver agreement was calculated. The reference standard was intraoperative appearance of the bowel wall (10/14; 71%) or the recovery of a normal bowel function in patients who were managed conservatively (4/14; 29%). RESULTS Among the 10 patients who underwent surgery, a normal appearance of the bowel in association with PI on CT was found intraoperatively in 8/10 (80%) patients and a reversible ischemia in the remaining 2/10 (20%) patients. The four patients who were managed conservatively recovered normal bowel function. Two patients died within two weeks following SBO. CONCLUSION PI and PVG are not specific signs of bowel necrosis in mechanical SBO.
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Affiliation(s)
- Paul Lebert
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France.
| | - Olivier Ernst
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Marc Zins
- Department of Radiology, Fondation Hôpital Saint-Joseph, 75014 Paris, France
| | - Marie Lanchou
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
| | - Jean-Robert Nzamushe
- Department of Emergency Surgery, Lille University Hospital, 59037 Lille Cedex, France
| | - Mathilde Vermersch
- Department of Digestive Diagnostic and Interventional Radiology, Lille University Hospital, 59037 Lille Cedex, France
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17
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D'errico F, Kotha S, Wong T, Berry P. Unexpected liver imaging during severe COVID-19 infection. Frontline Gastroenterol 2021; 13:178-179. [PMID: 35291718 PMCID: PMC8098289 DOI: 10.1136/flgastro-2021-101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Francesca D'errico
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Sreelakshmi Kotha
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Terry Wong
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Philip Berry
- Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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18
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Martín-Soberón MC, Ruiz S, De Velasco G, Yarza R, Carretero A, Castellano D, Sepúlveda-Sánchez JM. Pneumatosis intestinalis in a radioactive iodine-refractory metastasic thyroid papillary carcinoma with BRAF V600E mutation treated with dabrafenib-trametinib: a case report. J Med Case Rep 2021; 15:109. [PMID: 33653337 PMCID: PMC7927265 DOI: 10.1186/s13256-020-02581-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumatosis intestinalis (PI) is a rare entity which refers to the presence of gas within the wall of the small bowel or colon which is a radiographic sign. The etiology and clinical presentation are variable. Patients with PI may present either with chronic mild non-specific symptoms or with acute abdominal pain with peritonitis. Some cases of intestinal pneumatosis have been reported as adverse events of new oncological treatments such as targeted therapies that are widely used in multiple tumors. CASE PRESENTATION A 59-year-old caucasian female with radioactive iodine-refractory metastatic thyroid papillary carcinoma with BRAFV600E mutation was treated with dabrafenib and trametinib as a compassionate use. After 4 months treatment, positron emission tomography-computed tomography (PET-CT) showed PI. At the time of diagnosis, the patient was asymptomatic without signs of peritonitis. The initial treatment was conservative and no specific treatment for PI was needed. Unfortunately, after dabrafenib-trametinib withdrawal, the patient developed tumor progression with significant clinical worsening. CONCLUSIONS This case report is, in our knowledge, the first description of PI in a patient treated with dabrafenib-trametinib. Conservative treatment is feasible if there are no abdominal symptoms.
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Affiliation(s)
- M C Martín-Soberón
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain.
| | - S Ruiz
- Nuclear Medicine Department, University Hospital 12 de Octubre, Madrid, Spain
| | - G De Velasco
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - R Yarza
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - A Carretero
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - D Castellano
- Medical Oncology Department, University Hospital 12 de Octubre, Madrid, Spain
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19
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Chen CC, Chen Y, Zhang YX, Chen ZH, Yang K. Case Report: A Rare Condition of Abdominal Pain: Chemotherapy Induced Portal Vein Pneumatosis Mimicking the Bowel Necrosis. Front Surg 2021; 8:620908. [PMID: 33693027 PMCID: PMC7938891 DOI: 10.3389/fsurg.2021.620908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/05/2021] [Indexed: 02/05/2023] Open
Abstract
Portal vein pneumatosis is the presence of air in the portal venous system, which is one of the classic radiologic features of bowel ischemia or necrosis. However, there are several other morbidities that can have portal vein pneumatosis as a complication. This is a case of a 44-year-old man who suffered from severe abdominal pain after chemotherapy for soft tissue sarcoma of his left hip. The physical signs, laboratory findings, as well as the portal venous pneumatosis sign of the CT scan strongly indicated the probability of bowel necrosis and subjected the treatment decision of the patient finally to laparotomy. However, nothing abnormal except a segment of swollen small intestine was detected. Caution should be kept in mind when encountering a patient with suspected bowel necrosis following chemotherapy since several chemotherapeutic agents could cause portal vein pneumatosis. Diagnostic laparoscopy might be a better option for such cases.
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Affiliation(s)
- Chong-Cheng Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Xin Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-Hua Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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20
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Latif E, Ahmed K, Zarour A. Extensive Aeroportia, Operate or Not to Operate? A Report of a Challenging Case. Cureus 2021; 13:e13295. [PMID: 33732558 PMCID: PMC7955958 DOI: 10.7759/cureus.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aeroportia is the presence of gas in the portal vein. It is considered an ominous radiological sign with poor outcomes. Historically, it was associated with bowel necrosis, and surgery was mandated in all cases. Herein, we present a challenging case of portal venous gas and its management. An 87-year-old male patient, with multiple co-morbidities, presented with abdominal pain. The computerized tomography (CT) scan showed extensive portal venous gas without evidence of bowel ischemia. Initially, he was managed conservatively, but his clinical condition deteriorated. So, an exploratory laparotomy was performed which revealed multiple superficial splenic abscesses covering the surface of the spleen and a pale segment of jejunum with questionable viability. Splenectomy was performed and second-look laparotomy was planned to assess the small bowel viability. Second-look laparotomy revealed dusky discoloration of 30 cm jejunal segment. The affected segment was resected. The patient improved after surgery and was discharged home. In conclusion, aeroportia (portal venous gas) is a radiological entity. The clinical condition of the patient must be kept in consideration to manage the patients optimally. However, if the patient deteriorates, a high index of suspicion for mesenteric ischemia and early surgical intervention are the keys to save the patients' life.
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Affiliation(s)
- Ejaz Latif
- Surgery, Hamad Medical Corporation, Doha, QAT
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21
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Asemota O, Shawyer A, Moffatt H, Lum Min SA. Hepatic portal venous gas: An incidental finding in a patient with pyloric stenosis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Kim MS, Kim J, Cho K, Yang H. Portomesenteric vein gas with pneumatosis intestinalis: successful conservative treatment. BMJ Case Rep 2021; 14:e241082. [PMID: 33504543 PMCID: PMC7843334 DOI: 10.1136/bcr-2020-241082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 01/29/2023] Open
Affiliation(s)
- Min Sung Kim
- Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, The Republic of Korea
| | - Jinsung Kim
- Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, The Republic of Korea
| | - Kwanghyun Cho
- Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, The Republic of Korea
| | - Heebum Yang
- Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, The Republic of Korea
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23
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Yamada S, Koitabashi K, Sakurada T. Portomesenteric venous gas: An unusual complication of peritoneal dialysis. Ther Apher Dial 2020; 24:735-736. [DOI: 10.1111/1744-9987.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/08/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Shohei Yamada
- Division of Nephrology and Hypertension Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Kenichiro Koitabashi
- Division of Nephrology and Hypertension Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
| | - Tsutomu Sakurada
- Division of Nephrology and Hypertension Department of Internal Medicine, St. Marianna University School of Medicine Kawasaki Japan
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24
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Cordella A, Bertolini G. Multiphase multidetector-row CT reveals different patterns of hepatic portal venous gas and pneumobilia. Vet Radiol Ultrasound 2020; 62:68-75. [PMID: 33245597 DOI: 10.1111/vru.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/06/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatic portal venous gas and pneumobilia (PB) are uncommon findings, indicating the accumulation of gas in the portal vein and its branches and in the biliary tree, respectively. Aims of this retrospective, descriptive study were to describe the computed tomographic (CT) features and visualization techniques of hepatic portal venous gas (HPVG) and PB in a group of small animal veterinary patients. The CT data of patients with HPVG and PB were retrospectively reviewed. Thin-section multiplanar reformatting and minimum intensity projection (MinIP) views were used to assess the acquired volume dataset. The CT features recorded were as follows: amount, aspect, distribution, and localization of the gas in the liver. Five patients were included (four dogs and one cat), two presenting HPVG and three with PB. Gas in HPVG presented a peripheral location, whereas in PB was characterized by a central location. The aspect of the gas was tubular in case of HPVG and mixed tubular and rounded in PB. An analogous number of animals between the two groups showed comparable amount (mild, moderate, and severe) and distribution (diffuse and focal). Thin-section CT can detect the presence of gas in the liver, and a combination of two-dimensional and thin-slab MinIP can differentiate between HPVG and PB in dogs and cats. The distinctive features are peripheral versus central location and tubular versus rounded aspect of the gas.
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Affiliation(s)
- Alessia Cordella
- Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, Padua, Italy
| | - Giovanna Bertolini
- Diagnostic and Interventional Radiology Division, San Marco Veterinary Clinic and Laboratory, Padua, Italy
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25
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Fujii M, Yamashita S, Tanaka M, Tashiro J, Takenaka Y, Yamasaki K, Masaki Y. Clinical features of patients with hepatic portal venous gas. BMC Surg 2020; 20:300. [PMID: 33246462 PMCID: PMC7694268 DOI: 10.1186/s12893-020-00973-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) is a rare clinical condition that is caused by a variety of underlying diseases. However, the factors that would permit accurate identification of bowel ischemia, requiring surgery, in patients with HPVG have not been fully investigated. METHODS Thirty patients that had been diagnosed with HPVG using computed tomography between 2010 and 2019 were allocated to two groups on the basis of clinical and intraoperative findings: those with (Group 1; n = 12 [40%]) and without (Group 2; n = 18 [60%]) bowel ischemia. Eleven patients underwent emergency surgery, and bowel ischemia was identified in eight of these (73%). Four patients in Group 1 were diagnosed with bowel ischemia, but treated palliatively because of their general condition. We compared the characteristics and outcomes of Groups 1 and 2 and identified possible prognostic factors for bowel ischemia. RESULTS At admission, patients in Group 1 more commonly showed the peritoneal irritation sign, had lower base excess, higher lactate, and higher C-reactive protein, and more frequently had comorbid intestinal pneumatosis. Of the eight bowel ischemia surgery patients, four (50%) died, mainly because of anastomotic leak following bowel resection and primary anastomosis (3/4, 75%). All except one patient in Group 2, who presented with aspiration pneumonia, responded better to treatment. CONCLUSIONS Earlier identification and grading of bowel ischemia according to the findings at admission should benefit patients with HPVG by reducing the incidence of unnecessary surgery and increasing the use of safer procedures, such as prophylactic stoma placement.
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Affiliation(s)
- Manato Fujii
- Department of Surgery, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan.
| | - Suguru Yamashita
- Department of Surgery, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan
| | - Mayuko Tanaka
- Department of Radiology, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan
| | - Jo Tashiro
- Department of Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Yoshiharu Takenaka
- Department of Surgery, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan
| | - Kazuki Yamasaki
- Department of Surgery, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan
| | - Yukiyoshi Masaki
- Department of Surgery, Ome Municipal General Hospital, 4-16-5, Higashi Ome, Ome-shi, Tokyo, 198-0042, Japan
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26
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Spiller KT, Eisenberg BW. Extensive hepatic portal venous gas and gastric pneumatosis in a cat. Vet Med Sci 2020; 7:593-599. [PMID: 33222419 PMCID: PMC8025634 DOI: 10.1002/vms3.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/30/2020] [Accepted: 10/25/2020] [Indexed: 01/05/2023] Open
Abstract
A 15-year-old female neutered Domestic Long Hair cat was presented for acute hematemesis. Initial diagnostic workup, including serum biochemistry panel, complete blood count and coagulation profile, was unremarkable. Abdominal ultrasound showed gastric mural thickening and non-obstructive gastric foreign material. Endoscopy was performed to remove the foreign matter and obtain biopsies. Significant abnormalities of the upper gastrointestinal (GI) tract were not noted endoscopically. Overnight, the patient required a packed red blood cell transfusion following two episodes of severe hematemesis, hypotension and collapse. Serial radiographs and ultrasound revealed hepatic portal venous gas (HPVG). Computed tomography (CT) scan confirmed massive gas accumulation within the liver and emphysematous gastritis. The patient became increasingly unstable and, given her rapid decline, humane euthanasia was elected. Gastric and duodenal histopathology showed inflammatory changes, spirochetosis and mucosal epithelial degeneration. HPVG is a rarely described finding and prognosis varies drastically depending on aetiology. To the best of our knowledge, this is the first description of portal vein gas documented on multiple imaging modalities, including CT, in a cat. The patient in this report had several potential risk factors including prior endoscopy, compromise of the intestinal barrier and evidence of gastric mural bacterial invasion.
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27
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Kim HJ, Kim HK. Idiopathic Hepatic Portal Venous Gas in a Healthy Young Man. Int J Gen Med 2020; 13:687-692. [PMID: 33061536 PMCID: PMC7519867 DOI: 10.2147/ijgm.s276438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background Hepatic portal venous gas (HPVG) is a pathological condition characterized by gas in the portal venous system and its branches. The clinical manifestations of HPVG range from benign to life-threatening conditions. Here, we present a rare case of HPVG accompanied by free air in a healthy young patient without any suspicious etiology. Case Presentation A 28-year-old man without any specific medical history complained of sudden-onset dyspnea. On admission, his vital signs were stable, and the laboratory tests and physical examinations were within normal range. A plain chest and abdominal film revealed subphrenic free air and HPVG. Contrast-enhanced computed tomography (CT) showed extensive portal venous gas throughout the liver; however, there were no abnormal findings indicative of the etiology. Considering the stable vital signs and the lack of physical findings suggesting a surgical acute abdomen, the patient was managed conservatively. On admission day 3, the subphrenic free air and HPVG shown in the initial study had almost resolved, with no new symptoms. He was discharged on the fourth day after admission without any complications. Esophagogastroduodenoscopy, colonoscopy, and colonography protocol CT scan showed no significant abnormalities. Conclusion This case suggests that idiopathic HPVG could appear in healthy patients complaining only of vague symptoms. Initial conservative management could be considered if HPVG does not result from a life-threatening condition that needs immediate management, and if the patient is stable.
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Affiliation(s)
- Hong Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
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28
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Dibra R, Picciariello A, Trigiante G, Labellarte G, Tota G, Papagni V, Martines G, Altomare DF. Pneumatosis Intestinalis and Hepatic Portal Venous Gas: Watch and Wait or Emergency Surgery? A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923831. [PMID: 32653891 PMCID: PMC7377522 DOI: 10.12659/ajcr.923831] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Patient: Female, 60-year-old Final Diagnosis: Pneumatosis intestinalis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Rigers Dibra
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Arcangelo Picciariello
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Giuseppe Trigiante
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Grazia Labellarte
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Giovanni Tota
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Vincenzo Papagni
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Gennaro Martines
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
| | - Donato F Altomare
- Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, Bari, Italy
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Abstract
OBJECTIVE. The purpose of this article is to provide an overview of the diagnostic and prognostic roles of CT in the management of acute mesenteric ischemia. CONCLUSION. Acute mesenteric ischemia is defined as inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury. The prognosis is poor without treatment. Contrast-enhanced CT has become the cornerstone of diagnosis to identify features of vascular disorders and of intestinal ischemic injury and to visualize bowel necrosis.
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30
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Panico C, di Meo M, Tammaro N, Pirozzi REM, Cusati B. Porto-mesenteric venous gas as a sign of gastric mucosal damage remitted after surgery: a case report. Acta Radiol Open 2020; 9:2058460120911586. [PMID: 32284881 PMCID: PMC7137391 DOI: 10.1177/2058460120911586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 02/17/2020] [Indexed: 11/15/2022] Open
Abstract
Porto-mesenteric venous gas (PMVG) is a severe sign of abdominal organs damage. Imaging diagnostic criteria allow the detection of PMVG and should be applied in the presence of severe symptoms and signs of abdominal organs damage. Our case had clinical signs of epigastric pain and abdominal tenderness and ultrasonography and computed tomography evidence of PMVG and gastric cancer. The subsequent surgery, without complications, induced PMVG to disappear and the patient to be dismissed from hospital.
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Affiliation(s)
- Camilla Panico
- Dipartimento di Scienze Biomediche Avanzate, Università di Napoli Federico II, Naples, Italy
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Camilla Panico, Università degli Studi di Napoli Federico II, via Pansini 5, Naples, 80131, Italy.
| | | | - Nicola Tammaro
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Dipartimento di Chirurgia Generale e Specialistica, Università di Napoli Federico II, Naples, Italy
| | - Raffaele EM Pirozzi
- ASL Napoli 2 NORD, Santa Maria delle Grazie, Italy
- Dipartimento di Chirurgia Generale e Specialistica, Università di Napoli “L. Vanvitelli,” Naples, Italy
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Wang M, Song J, Gong S, Yu Y, Hu W, Wang Y. Hepatic portal venous gas with pneumatosis intestinalis secondary to mesenteric ischemia in elderly patients: Two case reports. Medicine (Baltimore) 2020; 99:e19810. [PMID: 32332623 PMCID: PMC7220781 DOI: 10.1097/md.0000000000019810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Hepatic portal venous gas (HPVG) is a rare imaging finding. When HPVG is accompanied with pneumatosis intestinalis (PI), the underlying cause is usually mesenteric ischemia with consequent intestinal necrosis. This combination of clinical conditions is associated with a poor prognosis. In this study, we present the cases of 2 elderly patients with HPVG and PI secondary to mesenteric ischemia. PATIENT CONCERNS In case 1, a 89-year-old male patient was admitted to intensive care unit with respiratory failure, On the fifth day of admission, he developed a high fever (39.5°C) and abdominal distension. In case 2, a 92-year-old male patient admitted to our intensive care unit and received mechanical ventilation due to acute respiratory failure. During the treatment, the patient developed gastrointestinal bleeding. On physical examination, abdominal bulging and tense abdominal walls were detected. Both patients underwent abdominal contrast-enhanced computed tomography, showed abundant HPVG with PI. DIAGNOSES The patients were diagnosed as acute mesenteric ischemia, bowel necrosis, septic shock, multiple organ dysfunction syndrome based on computed tomography scan, abdominal signs, and laboratory tests. INTERVENTIONS Fluid resuscitation, high-dose vasopressors, and intravenous antibiotic therapy were given. OUTCOMES Despite prompt treatment, the condition of both patients rapidly deteriorated, and the patients died shortly thereafter. CONCLUSION Mesenteric ischemia is a clinical emergency. In patients with risk factors and abdominal signs, the clinical suspicion for this condition should be high. Although rare, both HPVG and PI are important radiological clues that usually indicate the presence of mesenteric ischemia with consequent intestinal necrosis.
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32
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Wheatley L, Williams M, Swinson B, Crawley-Smith T. Benign harbinger of portal venous gas and pneumatosis intestinalis. ANZ J Surg 2020; 90:1803-1805. [PMID: 31994306 DOI: 10.1111/ans.15693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/29/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Lucas Wheatley
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Defence, The University of Queensland, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Michael Williams
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Benjamin Swinson
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Thomas Crawley-Smith
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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33
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Abstract
Portal venous system evaluation is required in many clinical circumstances, as substantial morbidity and mortality can be associated with a spectrum of portal vein abnormalities. Portal venous system pathologies can be congenital or acquired, and the knowledge of their imaging appearances will allow for a confident diagnosis and appropriate treatment options. In addition, a firm understanding of anatomical variants is important for planning surgical procedures and percutaneous interventions of the liver. This article will review various imaging appearances of portal venous systems abnormalities.
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Manfredi S, Fabbi M, Bonazzi M, Leonardi F, Miduri F, Parroccini I, Daga E, Gnudi G, Volta A. Ultrasonographic differentiation between portal venous and parenchymal gas may be important for the prognosis of canine and feline hepatic emphysema: 37 cases. Vet Radiol Ultrasound 2019; 60:734-744. [PMID: 31418983 DOI: 10.1111/vru.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/26/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of this retrospective, cross-sectional, study was to evaluate clinical findings and outcomes for different ultrasonographic patterns of hepatic emphysema in dogs and cats. Dogs and cats with an ultrasonographic diagnosis of hepatic emphysema and a known outcome, from January 2010 to January 2018, were enrolled. The following data were recorded from medical and ultrasonographic records: ultrasonographic patterns of hepatic emphysema (parenchymal, portal venous, biliary), clinical signs, laboratory findings, and outcomes (favorable, poor). A total of 33 dogs and four cats met the inclusion criteria. Among these, 23 cases were classified as hepatic portal venous gas, 10 as parenchymal emphysema, and four as biliary emphysema. Clinical diagnosis categories were as follows: infection/sepsis (9), gastro-intestinal disease (9), iatrogenic (9), trauma (5), and liver neoplasia (5). An increase in serum liver enzymes was significantly associated with parenchymal emphysema (P = .03). Other clinical and laboratory findings were not associated with the type of hepatic emphysema. Hepatic portal venous gas was mostly transient in patients with ultrasonographic follow-up. The overall mortality was 40.5%. A significant difference was found between mortality by portal venous gas (21.7%) and mortality by parenchymal emphysema (90%) (P = .003). In conclusion, the ultrasonographic differentiation of hepatic emphysema between hepatic portal venous gas and parenchymal emphysema may be important for the prognosis of hepatic emphysema. The presence of parenchymal emphysema may be a poor prognostic indicator, while hepatic portal venous gas may be more benign. However, ultrasound findings should be carefully evaluated in the context of clinical findings.
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Affiliation(s)
- Sabrina Manfredi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Martina Fabbi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Mattia Bonazzi
- Department of Veterinary Science, University of Parma, Parma, Italy.,Casa di Cura Veterinaria San Geminiano, Modena, Italy
| | - Fabio Leonardi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Francesca Miduri
- Department of Veterinary Science, University of Parma, Parma, Italy
| | | | - Eleonora Daga
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Giacomo Gnudi
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Antonella Volta
- Department of Veterinary Science, University of Parma, Parma, Italy
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Affiliation(s)
- Osama Dasa
- Division of Hospital Medicine, University of Florida, Gainesville, Florida
| | | | - Mohammed Ruzieh
- Penn State Heart and Vascular Institute, Hershey, Pennsylvania
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González-Rodríguez I, Morales-Uribe J, Colmenares-Chacón M. Secondary pneumatosis cystoides intestinalis complicated by intestinal volvulus: A case report and literature review. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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González-Rodríguez IC, Morales-Uribe JA, Colmenares-Chacón ML. Secondary pneumatosis cystoides intestinalis complicated by intestinal volvulus: A case report and literature review. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2019; 84:416-418. [PMID: 30661712 DOI: 10.1016/j.rgmx.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Affiliation(s)
- I C González-Rodríguez
- Servicio de Cirugía General, IVSS Hospital Dr. José María Carabaño Tosta, Maracay, Aragua, Venezuela.
| | - J A Morales-Uribe
- Servicio de Cirugía General, IVSS Hospital Dr. José María Carabaño Tosta, Maracay, Aragua, Venezuela
| | - M L Colmenares-Chacón
- Servicio de Cirugía General, IVSS Hospital Dr. José María Carabaño Tosta, Maracay, Aragua, Venezuela
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Wong CS, Cho G, Godfrey EM, Harper S. Portal pyaemia secondary to colonic perforation. BMJ Case Rep 2019; 12:12/4/e228400. [PMID: 30992283 DOI: 10.1136/bcr-2018-228400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Portal pyaemia or pylephlebitis is a form of septic (often suppurative) thrombophlebitis of the portal venous system. It may develop as a complication of intra-abdominal sepsis, such as diverticulitis or appendicitis. Patients typically present with a high fever that is sometimes accompanied by jaundice. We report a case of portal pyaemia associated with multiple liver abscesses and discuss the medical and surgical management of this condition.
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Affiliation(s)
- Chee Siong Wong
- Department of Hepatopancreaticobiliary Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, UK
| | - Gyuseong Cho
- Department of Hepatopancreaticobiliary Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, UK
| | - Edmund M Godfrey
- Department of Radiology, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Simon Harper
- Department of Hepatopancreaticobiliary Surgery, Cambridge University Hospital, Cambridge, Cambridgeshire, UK
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Chen H, Wu Q, Fang H, Liang B, Fang L. Intestinal necrosis cannot be neglected in a patient with hepatic portal vein gas combined with appendicitis: a rare case report and literature review. BMC Surg 2019; 19:17. [PMID: 30717721 PMCID: PMC6360744 DOI: 10.1186/s12893-019-0478-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hepatic portal vein gas (HPVG) is a rare acute abdomen, which is not an independent disease. Meanwhile, HPVG combined with appendicitis has been rarely reported. We found only a similar report by looking for literature, but no intestinal necrosis occurred. We report a patient with HPVG, appendicitis and intestinal necrosis was reported in the current study. The patient was given frequent monitoring and had been conducted operation in time. CASE PRESENTATION An 86-year-old female with appendicitis complicated by HPVG was reported in the present study. Abdominal examination revealed rebound tenderness at the McBurney's point. Moreover, abdominal computed tomography (CT) revealed gas in portal and mesenteric veins in addition to appendicitis. An emergency operation was planned on the appendix. However, the patient refused surgical treatment. Therefore, conservative treatment of antibiotics and frequent imaging observation was conducted for this patient. Although imaging results suggested disappeared gas in intra- and extra-hepatic portal veins, the small intestine was dilated, after conservative treatment of antibiotics. In addition, signs of diffused peritonitis could also be observed and an exploratory laparotomy was performed. Intra-operative findings had confirmed suppurated appendix, mesenteric ischemia and small intestinal necrosis. CONCLUSIONS Frequent monitoring benefits us in observing the progress of intestinal diseases. When there exist other possible causes of HPVG such as infection, it is not easy for us to ignore the possibility of intestinal necrosis.
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Affiliation(s)
- Haimin Chen
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
| | - Qingsong Wu
- Department of Hepatobiliary Surgery, Yuebei people‘s hospital, Shaoguan, Guangdong China
| | - Hongcai Fang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Jiujiang University, Jiujiang, Jiang xi China
| | - Bo Liang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
| | - Lu Fang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital, Nanchang University, No. 1, mingde road, Nanchang, Jiang xi China
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Schwartz T, Gough-Fibkins S, Santini R, Kopylov D. Abdominal CT Scan Findings of Decompression Sickness: A Case Report. J Radiol Case Rep 2019; 12:17-23. [PMID: 30651907 DOI: 10.3941/jrcr.v12i10.3425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This case report depicts the radiologic findings of a 51-year-old male presenting with Decompression Sickness. Decompression Sickness is diagnosed clinically, therefore radiologic imaging of this disease entity is limited. Our patient's history includes a scuba dive to depth of 110 feet with a descending time of 24 minutes and an ascending time of 8 minutes. The patient subsequently presented to the Emergency Room with symptoms of shortness of breath and abdominal pain. The abdominal pain prompted physicians to explore further, and hence computed tomography (CT) imaging of the abdomen and pelvis was performed. This case report demonstrates a striking and unique gas pattern in both the systemic and portal venous system of our patient and provides an excellent example of the imaging findings of Decompression Sickness in the literature.
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Affiliation(s)
- Taylor Schwartz
- Nova Southeastern University College of Medicine, Davie, FL, USA
| | | | - Roberta Santini
- Department of Radiology, Plantation General Hospital, Plantation, FL, USA
| | - David Kopylov
- Department of Radiology, Hahnemann University Hospital, Philadelphia, PA, USA
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Pathologic Intracardiac Bubbles in Patients With Cirrhosis: The Case for an Intestinal Origin. CASE (PHILADELPHIA, PA.) 2018; 3:18-21. [PMID: 30828678 PMCID: PMC6382950 DOI: 10.1016/j.case.2018.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kouzu K, Kajiwara Y, Aosasa S, Ishibashi Y, Yonemura K, Okamoto K, Shinto E, Tsujimoto H, Hase K, Ueno H. Hepatic portal venous gas related to appendicitis. J Surg Case Rep 2018; 2018:rjy333. [PMID: 30619544 PMCID: PMC6305834 DOI: 10.1093/jscr/rjy333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/29/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic portal venous gas (HPVG) is rare with high mortality. There are few reports on HPVG's association with appendicitis. Here we report a case of HPVG associated with appendicitis. Case presentation: A 79-year-old man presented with acute abdominal pain. Physical examination suggested peritoneal irritation. Blood tests indicated acute inflammation, metabolic acidosis, renal dysfunction and disseminated intravascular coagulation. Contrast-enhanced abdominal computed tomography revealed HPVG, a contrast defect in the small intestine, and minor ascites around the intestine. Urgent laparotomy was performed as intestinal ischemia was suspected. There were no findings of intestinal ischemia, but the appendix was discolored with wall thickening. We confirmed a clinical diagnosis of peritonitis caused by gangrenous appendicitis. We performed appendectomy and abdominal drainage. After surgery, the patient needed intensive care for septic shock. He left the ICU 7 days after the surgery and was discharged 10 days later. Conclusion: Thus, appendicitis may cause HPVG.
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Affiliation(s)
- Keita Kouzu
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Suefumi Aosasa
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Yusuke Ishibashi
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Keisuke Yonemura
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Japan
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Madhusudhan KS, Vyas S, Sharma S, Srivastava DN, Gupta AK. Portal vein abnormalities: an imaging review. Clin Imaging 2018; 52:70-78. [DOI: 10.1016/j.clinimag.2018.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/01/2018] [Accepted: 07/04/2018] [Indexed: 12/20/2022]
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Ko S, Hong SS, Hwang J, Kim HJ, Chang YW, Lee E. Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features. ACTA ACUST UNITED AC 2018; 64:543-548. [PMID: 30304313 DOI: 10.1590/1806-9282.64.06.543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS All CT reports containing the word "pneumatosis" were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.
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Affiliation(s)
- Sujin Ko
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Hyun-Joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Yun-Woo Chang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Eunji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, South Korea
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Sugi MD, Menias CO, Lubner MG, Bhalla S, Mellnick VM, Kwon MH, Katz DS. CT Findings of Acute Small-Bowel Entities. Radiographics 2018; 38:1352-1369. [DOI: 10.1148/rg.2018170148] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Mark D. Sugi
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Christine O. Menias
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Meghan G. Lubner
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Vincent M. Mellnick
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Matt H. Kwon
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
| | - Douglas S. Katz
- From the Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.D.S., C.O.M.); Department of Radiology, University of Wisconsin Hospital, Madison, Wis (M.G.L.); Division of Diagnostic Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B., V.M.M.); Stony Brook University School of Medicine, Stony Brook, NY (M.H.K.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.)
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Asahi Y, Suzuki T, Sawada A, Kina M, Takada J, Gotoda H, Masuko H. Pneumatosis Cystoides Intestinalis Secondary to Sunitinib Treatment for Gastrointestinal Stromal Tumor. Case Rep Gastroenterol 2018; 12:432-438. [PMID: 30186096 PMCID: PMC6120377 DOI: 10.1159/000490657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022] Open
Abstract
A 67-year-old man with liver and retroperitoneal metastases from a gastrointestinal stromal tumor arising in the jejunum had been administered oral sunitinib for 2 months. He presented to our department with right-sided lower abdominal pain. His general condition was good, with no high-grade fever, and the other vital signs were also stable. Contrast-enhanced computed tomography was promptly performed, and pneumatosis cystoides intestinalis (PCI) was detected in a wide area around the ileocecal lesion. There were no signs of acute abdomen requiring emergency surgery due to conditions such as intestinal perforation, ischemia, or obstruction. Sunitinib was discontinued and the patient was placed on nil orally with intravenous infusion. PCI resolved promptly and the patient was discharged on the 21st day after admission. PCI is a rare side effect of sunitinib with only 8 cases reported previously, which can complicate with acute abdomen or gastrointestinal perforation, in some cases. Thus, the early identification of sunitinib as the cause of PCI is important. Although PCI is a rare adverse effect of sunitinib, clinicians must be aware of it to promptly provide the correct diagnosis and treatment.
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Affiliation(s)
- Yoh Asahi
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Takuto Suzuki
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Akiufumi Sawada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Masaya Kina
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Joji Takada
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Hiroko Gotoda
- Department of Clinical Pathology, Nikko Memorial Hospital, Muroran, Japan
| | - Hiroyuki Masuko
- Department of Gastroenterological Surgery, Nikko Memorial Hospital, Muroran, Japan
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Capolupo GT, Mascianà G, Carannante F, Caricato M. Hepatic portal venous gas after colonoscopy: A case report and review. Int J Surg Case Rep 2018; 51:54-57. [PMID: 30144710 PMCID: PMC6107896 DOI: 10.1016/j.ijscr.2018.06.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/06/2018] [Indexed: 12/13/2022] Open
Abstract
Here we reported a rare case of hepatic portal venous gas with a relevant review of literature. Actually the mechanism of HPVG is still unknown. The case present in literature are few and the mortality, generally caused by complications like necrotizing enterocolitis, is still high.
Introduction Hepatic portal venous gas (HPVG) is a rare radiological finding in which gas enters the portal venous system and it is associated in case of necrotizing colitis with a mortality of 75%. We report a case of iatrogenic HPVG with a review of literature. Presentation of case A 41 years old patient underwent total colectomy and ileal pouch- anal anastomosis with derivative ileostomy for a familiar adenomatous polyposis coli in June 2008. A stenosis of the pouch-anal anastomosis developed. The patient underwent several endoscopic dilations. A recurrence of the stenosis was observed. The patient underwent to several endoscopic procedure. After the last colonoscopy the patient showed a fever with abdominal pain. A CT scan showed little peri-anastomotic collections and massive hepatic portal venous gas. Discussion The management of HPVG varied from surgical intervention to non-operative procedure. The surgical approach it's reserved to clinically unstable patients or those with evidence of peritonitis or bowel perforation. Stable patients, like those with an HPVG consequence of an endoscopic procedure, can be treated with non- operative management. Conclusion Our experience confirm that hepatic portal venous gas can be related to endoscopic procedure; thus, it can be managed on the basis of patient's general clinical conditions, and in selected cases it will disappear without therapeutic interventions with a good outcome.
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Affiliation(s)
- G T Capolupo
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
| | - G Mascianà
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy.
| | - F Carannante
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
| | - M Caricato
- Institute of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21 - 00128 Rome, Italy
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Derinkuyu BE, Boyunaga OL, Damar C, Unal S, Ergenekon E, Alimli AG, Oztunali C, Turkyilmaz C. Hepatic Complications of Umbilical Venous Catheters in the Neonatal Period: The Ultrasound Spectrum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1335-1344. [PMID: 29034490 DOI: 10.1002/jum.14443] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Umbilical venous catheterization is commonly used in the neonatal period; however, it has some complications. In this study, we evaluated neonates who underwent umbilical venous catheterization and developed hepatic complications. Furthermore, we aimed to define all of the possible lesions and to clarify the imaging findings of umbilical venous catheter-induced hepatic injury. METHODS Two hundred forty-four neonates who underwent umbilical venous catheterization between March 2013 and September 2015 in a single tertiary care referral center were included in this study. To determine whether they had any hepatic complications, all patients underwent abdominal grayscale and Doppler ultrasound examinations, and their clinical data were recorded. RESULTS The frequency of liver-related complications from umbilical venous catheterization was 33.6% (82 of 244). Air in the portal venous system was the most frequent complication (20.1% [49 of 244]). Left portal venous thrombosis was noted in 6.1% (15 of 244). Parenchymal lesions in the liver related to umbilical venous catheterization were seen in 7.4% of patients (18 of 244) as follows: single nodular echogenic lesions (4.1% [10 of 244]), branching small nodular echogenic lesions (2.1% [5 of 244]), and large irregular heterogeneous lesions with laceration and perihepatic fluid (1.2% [3 of 244]). There was no statistical significance for any type of complication according to the gestational age (P > .05). CONCLUSIONS Hepatic complications due to umbilical venous catheters are not uncommon in the neonatal period. Ultrasound is the best imaging modality for confirming the diagnosis and for follow-up.
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Affiliation(s)
- Betul Emine Derinkuyu
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Oznur Leman Boyunaga
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cagri Damar
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sezin Unal
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Ergenekon
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Gul Alimli
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Cigdem Oztunali
- Departments of Pediatric Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Canan Turkyilmaz
- Departments of Neonatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Walczak R, Paek M, Suran J, Amory JT, Specchi S, Sanchez M. Radiography and ultrasonography of pneumatosis intestinalis in a cat. Vet Radiol Ultrasound 2018; 61:E26-E30. [DOI: 10.1111/vru.12635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/14/2018] [Accepted: 02/21/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Raelyn Walczak
- Department of RadiologyGulf Coast Veterinary Specialists Houston TX 77027
| | - Matthew Paek
- Department of RadiologySynergy Veterinary Imaging Partners Rockville MD 21029
| | - Jantra Suran
- Section of RadiologyUniversity of Pennsylvania Philadelphia PA 19104
| | - Joseph T. Amory
- Department of RadiologyIDEXX Telemedicine Consultants Clackamas OR 97015
| | - Swan Specchi
- Department of Clinical SciencesIstituto Veterinario di Novara Strada Provinciale 9 Granozzo con Monticello Italy
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