MedPix® Patient Chart - Case No: 11412 :: - Review Images

A 64 year old male with microscopic hematuria

None provided

- Review Images for PT: 11412

Incidentally noted there is a significant amount of air present within the walls of multiple bowel loops, with associated pneumoperitoneum.

- Review Images for PT: 11412

Bowel ischemia
Iatrogenic from prior intervention
Idiopathic

- Review Images for PT: 11412

Dx: Pneumatosis cystoides intestinalis - Idiopathic

Dx Confirmed by: Imaging findings along with further patient history revealing that he did not have any abdominal pain and upon subsequent imaging the pneumatosis and pneumoperitonium resolved without intervention.

- Read

Pneumatosis cystoides intestinalis represents multiple noncommunicating, thin-walled gas-filled cysts within the wall of the intestines. It may appear as curvilinear, linear or round collections of air which can range in size from several mm to greater than 1 cm in size. It occurs when there has been damage of the bowel mucosa and passage of gas into the wall produced by bacterial superinfection. Primary pneumatosis occurs in 15% of cases and has no identifiable cause. Secondary pneumatosis accounts for 85% of cases with varied etiologies. The more common etiologies are COPD, intestinal obstruction, intestinal ischemia, and infection. It is seen more commonly in the large colon involving the mesenteric side of the bowel wall. All wall layers may be affected, with the most common being the subserosal and submucosal layers. Associated findings include pneumoperitoneum and gas within the portal and mesenteric vessels. The presence of which does not always indicate poor prognosis. The prognosis varies widely from spontaneous resolution to a fatal outcome depending largely upon the etiology.