CASE 13509 Published on 17.04.2016

Pneumatosis cystoides intestinalis


Abdominal imaging

Case Type

Clinical Cases


Luis Gijón de la Santa, José Antonio Pérez Retortillo, Emilio José Valbuena Durán

Hospital Universitario de Guadalajara (España);
C/Donantes de Sangre s/n, Spain;

93 years, female

Area of Interest Abdomen ; Imaging Technique CT, Conventional radiography
Clinical History
A 93-year-old woman with a history of congestive heart failure cane to the emergency room because of worsening of her habitual dyspnoea, cough and mild expectoration. No other symptoms were identified.
Imaging Findings
Chest X-ray plain film (Fig. 1) did not show lung consolidations but revealed a massive pneumoperitoneum as incidental finding.
MDCT was performed (Fig. 2) proving the pneumoperitoneum and revealing multiple air-filled rounded lesions inside. Due to the absence of abdominal symptoms and the imaging diagnosis of pneumatosis cystoides conservative treatment and follow-up MDCT was performed.
The patient was also diagnosed with decompensated heart failure.
A month later MDCT (Fig. 3) showed multiple rounded air-filled lesions occupying the anterior part of the mesentery and resolution of the pneumoperitoneum proving the imaging diagnosis of pneumatosis cystoides.
Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by multiple gas-filled cysts located in the submucosa and subserosa of the intestine [1-7]. The vast majority occurs in small bowel (especially jejunum and ileum), with only 6% of cases involving the colon.
This form of pneumatosis is considered benign and usually found as an incidental finding on a radiograph but must be differentiated from secondary forms related to other diseases (chronic obstructive pulmonary disease, scleroderma...) or certain drugs (steroids, gefitinib...). It is also necessary to exclude potentially life-threatening situations of pneumatosis such as intestinal ischaemia [1-7].
If the patient is stable and in absence of other complications treatment should be conservative even in the presence of pneumoperitoneum [5].
Differential Diagnosis List
Pneumatosis cystoides intestinalis
Perforated hollow viscus
Intestinal ischaemia
Secondary forms related to other diseases (chronic obstructive pulmonary disease
Final Diagnosis
Pneumatosis cystoides intestinalis
Case information
DOI: 10.1594/EURORAD/CASE.13509
ISSN: 1563-4086