CASE 13509 Published on 17.04.2016
0

Pneumatosis cystoides intestinalis

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

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;
Email:luigigijon@gmail.com
Connected authors
Patient

93 years, female

Categories
Area of Interest Abdomen ; Imaging Technique CT, Conventional radiography
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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.
Discussion
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
scleroderma...)
Final Diagnosis
Pneumatosis cystoides intestinalis
Case information
URL: https://www.eurorad.org/case/13509
DOI: 10.1594/EURORAD/CASE.13509
ISSN: 1563-4086
License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Figure 1

X-ray plain film

X-ray plain film
AP and lateral X-ray plain film revealed a massive pneumoperitoneum. No other findings were found except for laminar atelectasis in the middle and lower right lobes due to compression and hypoventilation.
Figure 2

MDCT

MDCT
Axial MDCT (A) and sagittal reconstruction (B) showed pneumoperitoneum with multiple air-filled rounded lesions inside. These findings raised the imaging suspicion of pneumatosis cystoides.
Figure 3

MDCT

MDCT
Follow-up axial MDCT (A) and coronal reconstruction (B) 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.