Chapter: Abdomen (Read entire chapter)
Diagnosis: Pneumatosis and portal venous gasPneumatosis in small bowel loops: air is seen within the bowel wall. You can differentiate intraluminal air from bowel wall air, if you see air within the dependent prortions of the bowel wall. Air rises - if it's within the bowel wall it can't! On supine plain films air in the bowel wall might also appear as speckled air lucencies. One etiology is bowel obstruction - as in this case. This patient has a small bowel obstruction.
Also noted is air in intrahepatic portal venous system. Portal venous gas comes usually from pneumatosis - the air is transported (usually via SMV) into the portal system. It might be confused by pneumobilia, however, portalvenous gas is more peripherally located in the liver, since it is pushed away in the direction of the portal venous flow.
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