Pneumatosis intestinalis: Difference between revisions

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{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
   Image          = Pneu2990058.jpg|
   Image          = Pneu2990058.jpg|
   Caption        = Pneumatosis intestinalis <br> (Image courtesy of RadsWiki)|
   Caption        = Pneumatosis Intestinalis <br> [http://www.radswiki.net Images courtesy of RadsWiki]|
  DiseasesDB    = |
  ICD10          = |
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  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = |
}}
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{{SI}}
'''For patient information on this topic, click [[Pneumatosis intestinalis (patient information)|here]].'''
{{Pneumatosis intestinalis}}
{{CMG}}
{{CMG}}


{{EH}}
==[[Pneumatosis intestinalis overview|Overview]]==


==Overview==
==[[Pneumatosis intestinalis pathophysiology|Pathophysiology]]==


'''Pneumatosis intestinalis''' is a [[sign (medicine)|sign]] on [[x-ray]] which is highly suggestive for [[necrotizing enterocolitis]]. The literal meaning is gas in the bowel wall, as opposed to in the lumen which is normal.
==[[Pneumatosis intestinalis causes|Causes]]==


*Pneumatosis intestinalis (PI) is defined as the presence of gas in the bowel wall.
==[[Pneumatosis intestinalis differential diagnosis|Differentiating Pneumatosis Intestinalis from other Conditions]]==
*PI is associated with numerous conditions, ranging from benign to life threatening.


==Etiologies of {{PAGENAME}} for adults==
==[[Pneumatosis intestinalis epidemiology and demographics|Epidemiology and Demographics]]==


===Benign causes include===
==[[Pneumatosis intestinalis risk factors|Risk Factors]]==


*Pulmonary: [[Asthma]], [[Bronchitis]], [[Emphysema]], [[Cystic fibrosis]]
==[[Pneumatosis intestinalis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
*Systemic disease: [[Scleroderma]], [[Systemic lupus erythematosus]]
*Intestinal causes: [[Enteritis]], [[Peptic ulcers]], [[Bowel obstruction]], [[Adynamic ileus]], [[Inflammatory bowel disease]], [[Diverticulitis]]
*Iatrogenic: Postsurgical anastomosis, [[Endoscopy]]
*Medications: [[Corticosteroid]]s, [[Chemotherapeutic agent]]s, [[Lactulose]]
*Organ transplantation
*Primary pneumatosis: Idiopathic, Pneumatosis cystoides intestinalis


===Life-threatening causes===
==Diagnosis==
*[[Ischemic bowel | Intestinal ischemia]]
*Mesenteric vascular disease
*[[Intestinal obstruction]] (especially strangulation)
*[[Colitis]]
*Ingestion of corrosive agents
*[[Toxic megacolon]]
*Trauma


==Two theories on pathogenesis of {{PAGENAME}}==
[[Pneumatosis intestinalis history and symptoms|History and Symptoms]] | [[Pneumatosis intestinalis physical examination|Physical Examination]] | [[Pneumatosis intestinalis laboratory findings|Laboratory Findings]] | [[Pneumatosis intestinalis x ray|X Ray]] | [[Pneumatosis intestinalis CT|CT]] | [[Pneumatosis intestinalis MRI|MRI]] | [[Pneumatosis intestinalis ultrasound|Ultrasound]] | [[Pneumatosis intestinalis other imaging findings|Other Imaging Findings]] | [[Pneumatosis intestinalis other diagnostic studies|Other Diagnostic Studies]]
*Mechanical theory: gas dissects into the bowel wall from either the intestinal lumen or the lungs via the mediastinum due to some mechanism causing increased pressure.
*Bacterial theory proposes that gas-forming bacilli enter the submucosa through mucosal rents or increased mucosal permeability and produce gas within the bowel wall.


==Imaging Findings==
==Treatment==
*Although PI can be seen on abdominal radiographs, CT is the most sensitive imaging test for identification of PI.
*On both radiographs and CT, PI usually appears as a low-density linear or bubbly pattern of gas in the bowel wall. It can be a combination of both linear and bubbly bowel-wall gas. There also may be circular collections of gas in the bowel wall.
*Viewing CT images with lung windows may accentuate the detection of PI, especially in the colon.
*Circular form of PI is usually benign and most often seen with pneumatosis cystoides intestinalis (PCI).
*Linear or bubble-like PI can be due to both benign and life-threatening causes, and its radiographic or CT appearance alone does not allow differentiation between them.
*The presence of additional findings such as bowel wall thickening, absent or intense mucosal enhancement, dilated bowel, arterial or venous occlusion, ascites, and hepatic portal or portomesenteric venous gas increases the possibility of PI due to a life-threatening cause.
*PI that is confined to a portion of the small or large bowel within a specific vascular distribution also increases the likelihood that ischemia is the cause of PI.
*Intraperitoneal or retroperitoneal free air can be seen with PI due to life-threatening or benign causes.


==Case Examples==
[[Pneumatosis intestinalis medical therapy|Medical Therapy]] | [[Pneumatosis intestinalis surgery|Surgery]] | [[Pneumatosis intestinalis prevention|Prevention]] | [[Pneumatosis intestinalis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Pneumatosis intestinalis future or investigational therapies|Future or Investigational Therapies]]


'''Case #1'''
==Case Studies==


[[Pneumatosis intestinalis case study one|Case #1]]


[http://www.radswiki.net Images courtesy of RadsWiki]
==Related Chapters==
 
<gallery>
Image:Pneumotosis-001.jpg
Image:Pneumotosis-002.jpg
Image:Pneumotosis-003.jpg
</gallery>
 
 
'''Case #2'''
 
 
[http://www.radswiki.net Images courtesy of RadsWiki]
 
<gallery>
Image:Pneumatosis-001.jpg
Image:Pneumatosis-002.jpg
Image:Pneumatosis-003.jpg
Image:Pneumatosis-004.jpg
</gallery>
 
 
'''Case #3: Pneumatosis intestinalis in this patient with aortic dissection.'''
 
Image shown below is courtesy of RadsWiki
 
<gallery>
Image:Pneu2990058.jpg
</gallery>
 
==See Also==
*[[Necrotizing enterocolitis]]
*[[Necrotizing enterocolitis]]
*[[Pneumoperitoneum]]
*[[Pneumoperitoneum]]
*Portal venous gas


==External Links==
==External Links==
*[http://goldminer.arrs.org/search.php?query=pneumatosis Goldminer: Pneumatosis]
*[http://goldminer.arrs.org/search.php?query=pneumatosis Goldminer: Pneumatosis]


==References==
* Ho, Lisa M., Paulson, Erik K., Thompson, William M. [http://www.ajronline.org/cgi/content/abstract/188/6/1604 Pneumatosis Intestinalis in the Adult: Benign to Life-Threatening Causes.] Am. J. Roentgenol. 2007 188: 1604-1613.


{{SIB}}


[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Radiologic signs]]
[[Category:Radiologic signs]]
[[Category:Radiology]]
[[Category:Radiology]]
[[Category:Signs and symptoms]]
 


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Latest revision as of 14:28, 12 June 2015

Pneumatosis intestinalis
Pneumatosis Intestinalis
Images courtesy of RadsWiki

For patient information on this topic, click here.

Pneumatosis Intestinalis Microchapters

Home

Patient Information

Overview

Pathophysiology

Causes

Differentiating Pneumatosis Intestinalis from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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Risk calculators and risk factors for Pneumatosis intestinalis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pathophysiology

Causes

Differentiating Pneumatosis Intestinalis from other Conditions

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

External Links


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