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Pneumatosis of the Intestine
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Cystic or linear collections of gas in subserosal or submucosal layers of gastrointestinal (GI) tract wall
              • Pneumatosis intestinalis: Most common form of intramural gas, found in small bowel more often than colon
              • Pneumatosis coli: Rounded collections of gas in distal colonic wall, usually asymptomatic finding
              • Pneumatosis is a descriptive sign, not a disease or diagnosis

            IMAGING

            • General Features

              • Fluoroscopic Findings

                • CT Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    • Laboratory Findings

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Milone M et al: Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia. World J Gastroenterol. 19(39):6579-84, 2013
                                          2. Zorgdrager M et al: Pneumatosis intestinalis associated with enteral tube feeding. BMJ Case Rep. 2013, 2013
                                          3. Pickhardt PJ et al: Asymptomatic pneumatosis at CT colonography: a benign self-limited imaging finding distinct from perforation. AJR Am J Roentgenol. 190(2):W112-7, 2008
                                          4. Saba L et al: Computed tomographic imaging findings of bowel ischemia. J Comput Assist Tomogr. 32(3):329-40, 2008
                                          5. Kim BN et al: Pneumatosis cystoides coli of the ascending colon: colonoscopic and CT colonographic features. Endoscopy. 39 Suppl 1:E73-4, 2007
                                          6. Kim KM et al: CT Colonography of pneumatosis cystoides intestinalis. Abdom Imaging. 32(5):602-5, 2007
                                          7. Mikami S et al: Education and imaging. Gastrointestinal: pneumatosis of the ascending colon. J Gastroenterol Hepatol. 22(5):760, 2007
                                          8. Romano S et al: Multidetector row computed tomography findings from ischemia to infarction of the large bowel. Eur J Radiol. 61(3):433-41, 2007
                                          9. Liu KL et al: Gastrointestinal: pneumatosis coli. J Gastroenterol Hepatol. 21(4):772, 2006
                                          10. Hou SK et al: Hepatic portal venous gas: clinical significance of computed tomography findings. Am J Emerg Med. 22(3):214-8, 2004
                                          11. Moisidou R et al: Typical CT findings of pneumatosis intestinalis and portal venous air in intestinal necrosis. Dig Surg. 21(3):184, 2004
                                          12. See C et al: Images in clinical medicine. Pneumatosis intestinalis and portal venous gas. N Engl J Med. 350(4):e3, 2004
                                          13. Sherman SC et al: Pneumatosis intestinalis and portomesenteric venous gas. J Emerg Med. 26(2):213-5, 2004
                                          14. Taourel P et al: Cecal pneumatosis in patients with obstructive colon cancer: correlation of CT findings with bowel viability. AJR Am J Roentgenol. 183(6):1667-71, 2004
                                          15. Kernagis LY et al: Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel. AJR Am J Roentgenol. 180(3):733-6, 2003
                                          16. St Peter SD et al: The spectrum of pneumatosis intestinalis. Arch Surg. 138(1):68-75, 2003
                                          17. SebastiĆ  C et al: Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics. 20(5):1213-24; discussion 1224-6, 2000
                                          18. Pear BL: Pneumatosis intestinalis: a review. Radiology. 207(1):13-9, 1998
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Cystic or linear collections of gas in subserosal or submucosal layers of gastrointestinal (GI) tract wall
                                                      • Pneumatosis intestinalis: Most common form of intramural gas, found in small bowel more often than colon
                                                      • Pneumatosis coli: Rounded collections of gas in distal colonic wall, usually asymptomatic finding
                                                      • Pneumatosis is a descriptive sign, not a disease or diagnosis

                                                    IMAGING

                                                    • General Features

                                                      • Fluoroscopic Findings

                                                        • CT Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            • Laboratory Findings

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Milone M et al: Computed tomography findings of pneumatosis and portomesenteric venous gas in acute bowel ischemia. World J Gastroenterol. 19(39):6579-84, 2013
                                                                                  2. Zorgdrager M et al: Pneumatosis intestinalis associated with enteral tube feeding. BMJ Case Rep. 2013, 2013
                                                                                  3. Pickhardt PJ et al: Asymptomatic pneumatosis at CT colonography: a benign self-limited imaging finding distinct from perforation. AJR Am J Roentgenol. 190(2):W112-7, 2008
                                                                                  4. Saba L et al: Computed tomographic imaging findings of bowel ischemia. J Comput Assist Tomogr. 32(3):329-40, 2008
                                                                                  5. Kim BN et al: Pneumatosis cystoides coli of the ascending colon: colonoscopic and CT colonographic features. Endoscopy. 39 Suppl 1:E73-4, 2007
                                                                                  6. Kim KM et al: CT Colonography of pneumatosis cystoides intestinalis. Abdom Imaging. 32(5):602-5, 2007
                                                                                  7. Mikami S et al: Education and imaging. Gastrointestinal: pneumatosis of the ascending colon. J Gastroenterol Hepatol. 22(5):760, 2007
                                                                                  8. Romano S et al: Multidetector row computed tomography findings from ischemia to infarction of the large bowel. Eur J Radiol. 61(3):433-41, 2007
                                                                                  9. Liu KL et al: Gastrointestinal: pneumatosis coli. J Gastroenterol Hepatol. 21(4):772, 2006
                                                                                  10. Hou SK et al: Hepatic portal venous gas: clinical significance of computed tomography findings. Am J Emerg Med. 22(3):214-8, 2004
                                                                                  11. Moisidou R et al: Typical CT findings of pneumatosis intestinalis and portal venous air in intestinal necrosis. Dig Surg. 21(3):184, 2004
                                                                                  12. See C et al: Images in clinical medicine. Pneumatosis intestinalis and portal venous gas. N Engl J Med. 350(4):e3, 2004
                                                                                  13. Sherman SC et al: Pneumatosis intestinalis and portomesenteric venous gas. J Emerg Med. 26(2):213-5, 2004
                                                                                  14. Taourel P et al: Cecal pneumatosis in patients with obstructive colon cancer: correlation of CT findings with bowel viability. AJR Am J Roentgenol. 183(6):1667-71, 2004
                                                                                  15. Kernagis LY et al: Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel. AJR Am J Roentgenol. 180(3):733-6, 2003
                                                                                  16. St Peter SD et al: The spectrum of pneumatosis intestinalis. Arch Surg. 138(1):68-75, 2003
                                                                                  17. SebastiĆ  C et al: Portomesenteric vein gas: pathologic mechanisms, CT findings, and prognosis. Radiographics. 20(5):1213-24; discussion 1224-6, 2000
                                                                                  18. Pear BL: Pneumatosis intestinalis: a review. Radiology. 207(1):13-9, 1998