E1915. Pneumatosis Intestinalis: A Case-Based Approach Throughout the GI Tract
  1. Sowmiya Murali ; University of New Mexico
  2. Lisa Richardson; University of New Mexico
  3. William Thompson ; University of New Mexico
Pneumatosis, an imaging finding often seen on Computed Tomography (CT) or abdominal radiograph, is the presence of air within the gastrointestinal mucosal wall which can occur anywhere in the gastrointestinal tract. Pneumatosis can be classified as either benign or life threatening. Benign pneumatosis is often asymptomatic, self-limiting, and often managed conservatively. Life-threatening pneumatosis on the other hand, refers to a clinically worrisome scenario where prompt intervention, such as surgery is necessary due to bowel necrosis). As the treatment of pneumatosis varies significantly, the distinction between the two is critical. There are numerous causes of benign and life threatening pneumatosis. Our purpose is to familiarize radiologists with causes of benign and life-threatening pneumatosis to help aid in characterization, as the radiologist will encounter pneumatosis in the emergency, inpatient and outpatient settings.

Educational Goals / Teaching Points
After viewing this exhibit, the learner will have a more comprehensive understanding of typical and atypical findings of pneumatosis in the esophagus, stomach, small bowel and large bowel with an emphasis on benign and life-threatening etiologies of pneumatosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
CT and abdominal radiography are imaging techniques used to diagnose pneumatosis, with CT shown to be more sensitive. Imaging features of pneumatosis intestinalis include bubbly or linear gas pattern with the bowel wall. Ascites, bowel wall dilation, absence or decreased bowel wall enhancement, hepatoportal or portomesenteric venous gas, bowel wall thickening, or arterial or venous occlusion are additional imaging features that aid in the characterization of life-threatening pneumatosis.

The imaging appearance of benign and life-threatening PI may look similar and will require correlation with physical examination and laboratory values. It is crucial to effectively distinguish between benign and life-threatening PI as the management varies significantly. Becoming familiar with the many causes of PI may help radiologists guide appropriate management.