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Pneumatosis in Older Children
Ethan A. Smith, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Pneumatosis intestinalis; pneumatosis coli (confined to colon); pneumatosis cystoides intestinalis
            • Definitions

              • Presence of gas within walls of gastrointestinal tract
                • Associated with necrotizing enterocolitis in
                  • Premature infants
                  • Term newborns with congenital heart disease & other cardiovascular abnormalities
                • In older children, more frequently benign & associated with variety of underlying conditions & medications

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • Ultrasonographic Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Treatment

                            Selected References

                            1. Ryan JL et al: Conservative management of pneumatosis intestinalis and portal venous gas after pediatric liver transplantation. Transplant Proc. 52(3):938-42, 2020
                            2. Chang CY et al: Benign pneumatosis intestinalis in a pediatric patient with multiple risk factors including granulomatosis with polyangiitis: a case report and review of the literature. Semin Arthritis Rheum. 44(4):423-7, 2015
                            3. Gui X et al: Is pneumatosis cystoides intestinalis gas-distended and ruptured lymphatics? Reappraisal by immunohistochemistry. Arch Pathol Lab Med. 138(8):1059-66, 2014
                            4. Lee KS et al: Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. AJR Am J Roentgenol. 200(5):1042-7, 2013
                            5. Korhonen K et al: Incidence, risk factors, and outcome of pneumatosis intestinalis in pediatric stem cell transplant recipients. Pediatr Blood Cancer. 58(4):616-20, 2012
                            6. Duron VP et al: Computed tomographic diagnosis of pneumatosis intestinalis: clinical measures predictive of the need for surgical intervention. Arch Surg. 146(5):506-10, 2011
                            7. Li S et al: Pneumatosis intestinalis in children with acute lymphoblastic leukemia and acute myeloid leukemia. Support Care Cancer. 20(2):343-7, 2011
                            8. Olson DE et al: CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology. 253(2):513-9, 2009
                            9. McCarville MB et al: Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients. Pediatr Radiol. 38(10):1074-83, 2008
                            10. Ho LM et al: Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 188(6):1604-13, 2007
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Top Differential Diagnoses

                                  • Pathology

                                    • Clinical Issues

                                      TERMINOLOGY

                                      • Synonyms

                                        • Pneumatosis intestinalis; pneumatosis coli (confined to colon); pneumatosis cystoides intestinalis
                                      • Definitions

                                        • Presence of gas within walls of gastrointestinal tract
                                          • Associated with necrotizing enterocolitis in
                                            • Premature infants
                                            • Term newborns with congenital heart disease & other cardiovascular abnormalities
                                          • In older children, more frequently benign & associated with variety of underlying conditions & medications

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • CT Findings

                                            • Ultrasonographic Findings

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  • Gross Pathologic & Surgical Features

                                                    CLINICAL ISSUES

                                                    • Treatment

                                                      Selected References

                                                      1. Ryan JL et al: Conservative management of pneumatosis intestinalis and portal venous gas after pediatric liver transplantation. Transplant Proc. 52(3):938-42, 2020
                                                      2. Chang CY et al: Benign pneumatosis intestinalis in a pediatric patient with multiple risk factors including granulomatosis with polyangiitis: a case report and review of the literature. Semin Arthritis Rheum. 44(4):423-7, 2015
                                                      3. Gui X et al: Is pneumatosis cystoides intestinalis gas-distended and ruptured lymphatics? Reappraisal by immunohistochemistry. Arch Pathol Lab Med. 138(8):1059-66, 2014
                                                      4. Lee KS et al: Distinguishing benign and life-threatening pneumatosis intestinalis in patients with cancer by CT imaging features. AJR Am J Roentgenol. 200(5):1042-7, 2013
                                                      5. Korhonen K et al: Incidence, risk factors, and outcome of pneumatosis intestinalis in pediatric stem cell transplant recipients. Pediatr Blood Cancer. 58(4):616-20, 2012
                                                      6. Duron VP et al: Computed tomographic diagnosis of pneumatosis intestinalis: clinical measures predictive of the need for surgical intervention. Arch Surg. 146(5):506-10, 2011
                                                      7. Li S et al: Pneumatosis intestinalis in children with acute lymphoblastic leukemia and acute myeloid leukemia. Support Care Cancer. 20(2):343-7, 2011
                                                      8. Olson DE et al: CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology. 253(2):513-9, 2009
                                                      9. McCarville MB et al: Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients. Pediatr Radiol. 38(10):1074-83, 2008
                                                      10. Ho LM et al: Pneumatosis intestinalis in the adult: benign to life-threatening causes. AJR Am J Roentgenol. 188(6):1604-13, 2007