Clinics in diagnostic imaging (128)

A 66-year-old man presented with epigastric pain. Computed tomography (CT) of the abdomen showed portal venous gas with partial thrombosis of the portal veins, consistent with portal pyaemia. CT also showed nonspecific peripancreatic fat stranding. The patient was treated conservatively but did not improve, necessitating a laparotomy that revealed ischaemic colitis and bowel necrosis. He underwent a right hemicolectomy and showed clinical improvement. Portal pyaemia is a combination of infection and thrombosis within the portal veins. The presence of gas in the portal vein is a known feature in portal pyaemia. We showed radiological examples of hepatic and portal venous gas in several patients who presented to our institution, with a brief discussion of their radiological findings, causes, management and outcome. The mortality rate of patients with portal venous gas depends on the underlying cause. The high mortality rate of patients with portal venous gas due to bowel necrosis or ischaemia may necessitate emergent surgical intervention.