The portal vein gas is the accumulation of gas in the portal vein and its branches. This process should be differentiated from pneumobilia, although this is not so ambiguous as the relevant signs are led along the gas distribution pattern (which is peripheral in the case of stationary gases. portal circuit, central in case of biliary gas).

Causes of portal vein gas

Despite the traditional view as a sign of death, portal venous gas has increasingly been reported in many cases, many of which are not associated with high mortality or disease risk. The causes of portal gas are divided according to the patient’s age.

• Children:
  • Umbilical venous catheterization
  • Necrotizing enterocolitis (NEC)
  • Neonatal gastroenteritis (Neonatal gastroenteritis)
  • Infant hemolytic disease (Erythroblastosis fetalis)
  • Postoperative in bowel repair surgery
• Adults:

The change in intestinal wall

• Intestinal anemia (usually gas in the intestinal wall as well as mesenteric gas: incidence is about 75-90%, but gas is not an independent prognostic factor).
• Ulcerated or necrotic colon-rectal carcinoma (necrotic / ulcerated colorectal carcinoma – CRC)
• Inflammatory bowel disease
• Perforation of the stomach ulcer

Bowel luminal distention

• Idiopathic gastrointestinal dilatation (e.g. oral or anal endoscopy, enemas)
• Mechanical intestinal obstruction or / paralysis
• Acute gastric dilatation
• Barotrauma

Infection in the abdomen

• Acute diverticulitis
• Infectious colitis
• Pelvic abscess
• Cholecystitis / cholangitis
• Appendicitis
• Hemorrhagic pancreatitis

The mechanism is unknown

• Pneumatosis intestinalis
• Chronic obstructive pulmonary disease (COPD)
• Use of corticosteroids
• Diabetes
• Diarrhea
• Cardiopulmonary resuscitation (CPR)

Photographic characteristics of portal vein gas

Supersonic

The portal vein gas often manifests as moving echogenic spots in the lumen of the portal vein. Doppler ultrasound will clearly demonstrate branches on both sides of the baseline of the pulsed Doppler window.

CT-scan

Like the x-ray characteristic, the venous gas manifests itself as CT’s low-density gas spots branching in the liver, portal vein, or their branches. The gas-venous line can create false image streaks. Typically, the gas is on the periphery of the liver, which helps to differentiate it from the central gas than in the case of the gas in the bile ducts.

Imaging of portal vein gas on x-ray film
Picture of portal vein gas on CT film

Source translated from Radiopaedia

References:

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