Portal venous gas
Updates to Article Attributes
Portal venous gas is the accumulation of gas in the portal vein and its branches. It needs to be distinguished from pneumobilia, although this is usually not too problematic when associated findings are taken into account along with the pattern of gas (i.e. peripheral in portal venous gas, central in pneumobilia).
Ultrasound
Gas in the portal veins usually manifests as echogenic mobile foci in the lumen of the portal vein.
Doppler
Associated with sharp spikes on both sides of the basal line on the Doppler spectral display 7.
Pathology
Aetiology
Although traditionally considered a harbinger of death, portal venous gas is increasingly recognised in a variety of conditions, many of which do not carry as high mortality or morbidity risks.
Causes of portal venous gas are best divided according to the age of the patient:
-
child
- umbilical vein catheterisation
- necrotising enterocolitis (NEC)
- neonatal gastroenteritis
- erythroblastosis fetalis
- postoperative finding in corrective bowel surgery
-
adult
- alterations of the bowel wall
- ischaemic bowel (usually mural gas as well as mesenteric gas: mortality of 75-90%, but gas is not an independent predictor)
- necrotic/ulcerated colorectal carcinoma (CRC)
- inflammatory bowel disease (IBD)
- perforated peptic ulcer
- bowel luminal distention
- iatrogenic gastric and bowel dilatation (e.g. upper and lower endoscopic procedures, enemas)
- paralytic ileus / mechanical bowel obstruction
- acute gastric dilatation 4
- barotrauma
- intra-abdominal sepsis
- unknown mechanism
- pneumatosis intestinalis
- chronic obstructive pulmonary disease (COPD)
- corticosteroid usage
- diabetes 8
- diarrhea 8
- cardiopulmonary resuscitation 9
- alterations of the bowel wall
Radiographic features
Plain X-ray
Branching lucencies projected in the liver or vessels coursing towards the liver.
Ultrasound
Gas in the portal veins usually manifests as echogenic mobile foci in the lumen of the portal vein. Doppler US will demonstrate sharp spikes on both sides of the basal line on the Doppler spectral display 7.
CT
Similar to X-ray features, portal venous gas manifests on CT as branching gaseous foci of low density in the liver, portal vein and it's tributaries. The vessel-gas interface may course streak artefact. Typically the gas in the liver is peripheral which helps differentiate it from more central gas due to pneumobilia).
See also
-<p><strong>Portal venous gas</strong> is the accumulation of gas in the <a href="/articles/portal-vein">portal vein</a> and its branches. It needs to be distinguished from <a href="/articles/pneumobilia">pneumobilia</a>, although this is usually not too problematic when associated findings are taken into account along with the pattern of gas (i.e. peripheral in portal venous gas, central in pneumobilia).</p><h4>Ultrasound</h4><p>Gas in the portal veins usually manifests as echogenic mobile foci in the lumen of the portal vein.</p><h5>Doppler</h5><p>Associated with sharp spikes on both sides of the basal line on the Doppler spectral display <sup>7</sup>.</p><h4>Pathology</h4><h5>Aetiology</h5><p>Although traditionally considered a harbinger of death, portal venous gas is increasingly recognised in a variety of conditions, many of which do not carry as high mortality or morbidity risks.</p><p>Causes of portal venous gas are best divided according to the age of the patient:</p><ul>- +<p><strong>Portal venous gas</strong> is the accumulation of gas in the <a href="/articles/portal-vein">portal vein</a> and its branches. It needs to be distinguished from <a href="/articles/pneumobilia">pneumobilia</a>, although this is usually not too problematic when associated findings are taken into account along with the pattern of gas (i.e. peripheral in portal venous gas, central in pneumobilia).</p><h4>Pathology</h4><h5>Aetiology</h5><p>Although traditionally considered a harbinger of death, portal venous gas is increasingly recognised in a variety of conditions, many of which do not carry as high mortality or morbidity risks.</p><p>Causes of portal venous gas are best divided according to the age of the patient:</p><ul>
-</ul><h4>See also</h4><ul><li><a href="/articles/abnormal-intraabdominal-gas">abnormal intra-abdominal gas</a></li></ul>- +</ul><h4>Radiographic features</h4><h5>Plain X-ray</h5><p>Branching lucencies projected in the liver or vessels coursing towards the liver.</p><h5>Ultrasound</h5><p>Gas in the portal veins usually manifests as echogenic mobile foci in the lumen of the portal vein. Doppler US will demonstrate sharp spikes on both sides of the basal line on the Doppler spectral display <sup>7</sup>.</p><h5>CT</h5><p>Similar to X-ray features, portal venous gas manifests on CT as branching gaseous foci of low density in the liver, portal vein and it's tributaries. The vessel-gas interface may course streak artefact. Typically the gas in the liver is peripheral which helps differentiate it from more central gas due to pneumobilia). </p><h4>See also</h4><ul><li><a href="/articles/abnormal-intraabdominal-gas">abnormal intra-abdominal gas</a></li></ul>
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