Abstract
Background
Portal venous gas has mainly been studied in pediatrics and seen in cases of necrotizing
enterocolitis. It is a rare finding in adults and is typically associated with underlying
intestinal ischemia or other malignant intra-abdominal pathology. Portal venous gas
is seen more readily on ultrasound compared to radiographs in both pediatric and adult
patients. Findings include lucencies extending to the periphery of the liver, echogenic
bubbles flowing centrifugally throughout the portal venous system, and bidirectional
spikes interrupting the monophasic portal venous waveform on spectral analysis.
Case Report
We present a case of a 36-year-old female who presented with abdominal pain. She had
findings consistent with portal venous gas on point-of-care ultrasound, prompting
computed tomography of her abdomen and surgical consultation. She was ultimately found
to have cecal ischemia from cecal volvulus, had surgical resection and anastomosis,
and was able to be discharged from the hospital following recovery.
Why Should an Emergency Physician Be Aware of This?
With the ever-increasing use of point-of-care ultrasound, emergency physicians should
be aware of the findings consistent with portal venous gas as well as its implications.
Emergency physicians should know portal venous gas is associated with intestinal ischemia
and other malignant pathologies and should prompt more advanced imaging or surgical
consultation when observed. Emergency physicians should also understand the distinctions
between portal venous gas and pneumobilia found on point-of-care ultrasound, given
that portal venous gas is typically a malignant finding and pneumobilia is most frequently
benign.
Keywords
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Article info
Publication history
Published online: December 13, 2019
Accepted:
October 27,
2019
Received in revised form:
October 13,
2019
Received:
June 22,
2019
Footnotes
Streaming video: Three brief real-time video clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1–3.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
