Gastric pneumatosis and portal vein gas: incidental findings at helical CT after blunt abdominal trauma

Gastric pneumatosis is a rare form of intestinal pneumatosis related to a wide range of abnormalities, which by itself may not engender adverse consequences. Portal vein gas, on the other hand, has traditionally been regarded as a life-threatening condition associated with mesenteric ischemia and immediate surgery; however, recent observations have demonstrated a greater spectrum of etiologies associated with portal vein gas in which the prognosis seems to be more favorable and surgery is not necessary. We report the case of a 42-year-old man who developed gastric pneumatosis and portal vein gas after major abdominal trauma. The patient was conservatively treated. Follow-up CT performed 4 days later revealed that portal vein gas and gastric pneumatosis had resolved spontaneously.     

Diagnosis of pneumatosis intestinalis coli in CT]

Pneumatosis intestinalis coli seldom causes symptoms of an acute abdomen and is rarely diagnosed in CT. The origin of the gas collections in the wall of the bowel often remains unclear. As shown in our case, pneumatosis may involve any portion of the bowel, but usually spares the rectum. Due to extreme meteorism and coprostasis it can be difficult to recognize pneumatosis radiographically. In CT the gas collections beneath the serosa are well defined, discrete, oval or round.     

Pneumatosis intestinalis in patients with ischemia: correlation of CT findings with viability of the bowel

OBJECTIVE: The purpose of our study was to reassess the CT finding of pneumatosis in intestinal ischemia to determine whether it indicates transmural necrosis versus partial mural ischemia and also to determine whether other CT findings can be used to predict which patients with pneumatosis are likely to have viable bowel. CONCLUSION: The CT finding of pneumatosis does not always indicate transmural infarction of the bowel in intestinal ischemia. Patients with associated portomesenteric venous gas are more likely to have transmural infarction than those with pneumatosis alone.     

Portomesenteric vein gas: diagnostic and prognostic value

Portomesenteric pneumatosis has been traditionally associated with intestinal infarction and poor outcome; however, recent studies have questioned its clinical value. To assess its diagnostic and prognostic significance we have retrospectively evaluated 47 patients correlating the CT finding of portomesenteric vein gas with clinical data and outcome. Thirty-nine patients (83%) had surgical evidence of intestinal infarction, four had necrotic small bowel volvulus (8.5%), two had blunt trauma, one had necrotic gastric volvulus, and one a gastric mucosal lesion induced by a nasogastric tube. Fifteen patients survived (31.9%); only 8/39 patients with intestinal infarction survived. Portomesenteric pneumatosis is a reliable marker of intestinal infarction and poor outcome; however, in trauma patients this sign is associated with a better prognosis. Electronic Publication     

胃癌螺旋CT术前评估及与手术病理分期对照研究

目的:应用螺旋CT行胃癌术前评估,并将CT分期与手术病理分期进行比较。方法:98例胃癌患者术前行腹部螺旋CT检查,并实施手术分期和病理分期。结果:所有患者行手术治疗,其中16例(16%)无法切除,82例(84%)手术切除。CT扫描中胃壁的厚度和浆膜的累及有相关性(P<0.001)。CT和手术预测病理分期的符合率分别为68%和52%。CT过度分期只有17%。结论:螺旋CT是胃癌患者术前检查的一种有效的方法,可预测胃癌病灶的可切除性,从而避免某些不必要的剖腹手术或使手术方案更加合理。CT过度分期的概率较低,其分期的准确率高于手术。     

胃癌螺旋CT与病理、nm23-H1蛋白表达的相关性研究

目的 探讨胃癌螺旋CT征象与手术病理及nm23-H1蛋白表达间的关系.资料与方法 对65例胃癌行低张力水充盈螺旋CT三期增强扫描,所有病例均行手术切除,术后标本采用免疫组织化学SP法检测肿瘤组织中nm23-H1蛋白表达.将螺旋CT诊断结果 与病理结果 、nm23-H1蛋白表达进行对照.结果 65例胃癌TNM分期CT的准确性为80.0%(52/65),nm23-H1蛋白阳性表达率为50.8%(33/65).CT像上的病灶大小、浆膜侵犯、淋巴结转移、TNM分期与病理结果 一致性良好,与nm23-H1蛋白阳性表达率均密切相关(P＜0.05).结论 螺旋CT可较准确地反映胃癌增殖、浸润转移的病理学及生物学特性.     

Cecal pneumatosis in patients with obstructive colon cancer: correlation of CT findings with bowel viability

OBJECTIVE: The purpose of our study was to reassess CT findings of cecal pneumatosis in patients with acute large-bowel obstruction due to colon cancer to determine whether this condition indicates transmural necrosis versus viable bowel and also whether other CT findings could be used to identify patients with transmural necrosis. CONCLUSION: CT findings of cecal pneumatosis do not always indicate transmural infarction in patients with acute large-bowel obstruction due to colon cancer. Cecal pneumatosis may be related to viable bowel when it displays a bubblelike pattern or when it is not associated with other findings of ischemia.     

多层螺旋CT在胃癌诊断中的应用

目的:评价多层螺旋CT检查及后处理技术在胃癌诊断中的应用.方法:40例经手术病理证实的胃癌患者行多层螺旋CT(MSCT)平扫、三期增强扫描和图像后处理,包括多平面重组(MPR)、最大密度投影(MIP)、表面遮盖显示(SSD)、透明法(Raysum)和仿真内镜(CTVE)检查,结合轴面图像和所有重组图像由两位有经验的CT诊断医师进行CT诊断及胃癌的术前评估分期,同时与手术病理结果进行对照.结果:40例胃癌患者MSCT诊断结果与胃镜诊断结果完全一致,与手术病理诊断符合率为100%.结论:MSCT对胃癌的诊断有其独特的优越性,很有必要广泛应用于临床.在MSCT的诊断分析中,应当把原始轴面图像、三维重组图像及CTVE图像充分结合,提高早期胃癌的检出率.     

双能量CT在胃癌影像评价中的临床研究进展

胃癌是最常见的消化系统恶性肿瘤,在临床中主要根据CT对胃癌进行分期及术前评估等。双能量CT成像是近年来出现的一种新型检查技术,与传统CT比较,不仅能有效地提高胃癌诊断的准确率和早期病灶的检出率,同时也在胃癌病理分型、分化程度及术前评估中具有独特的优势。就双能量CT的成像原理及其在胃癌临床应用中的价值进行综述。     

胃癌浸润转移:螺旋CT与病理、COX-2蛋白及mRNA表达的相关性研究

目的 探讨胃癌螺旋CT浸润转移与病理及环氧合酶（COX）-2蛋白表达间的关系。资料与方法 对57例胃癌行低张力水充盈螺旋CT三期增强扫描,所有病例均行手术切除,术后标本采用免疫组织化学SP法、原位杂交实验检测肿瘤组织中COX-2蛋白、mRNA表达。将螺旋CT结果与病理结果、COX-2表达进行对照。结果 57例胃癌螺旋CT浸润深度的准确性为82．5％（47／57）,淋巴结转移的准确性为78．9％（45／57）,4例胃癌发生远处转移螺旋CT均正确诊断,TNM分期的准确性为80．7％（46／57）。COX-2蛋白及mRNA阳性表达率分别为61．4％（35／57）和73．7％（42／57）。CT对胃癌浸润深度、淋巴结转移、TNM分期与病理一致性良好,与COX-2蛋白及mRNA表达率均密切相关（P〈0．05）。结论 螺旋CT可较准确地反映胃癌浸润转移的病理学及生物学特性,从而可指导手术、化学预防和治疗以及评估预后。     

Echographic and x-ray computed tomographic aspects of pneumatosis cystoides of the colon in the adult. Apropos of a case

A case of pneumatosis cystoides Coli located in the sigmoid in an adult is reported, with emphasis on US and CT aspects. CT patterns of pneumatosis cystoides Coli are highly significative; particularly attenuation values measured in the endoluminal polypoid images are characteristics and represent an interesting contribution to the diagnosis of this disease.     

Gastric pneumatosis as a sign of duodenal stenosis in a child with Down syndrome

A case of gastric pneumatosis is described in a 6 month old girl with Down syndrome. Plain abdominal radiographs showed a radiolucent rim within the gastric wall and a dilated stomach. Ultrasonography showed diffuse echoic streaks of air in the gastric wall, pneumobilia and gastroduodenal dilatation. Upper GI series showed duodenal stenosis. Gastric pneumatosis (air within the gastric wall), is an unusual radiographic finding. It may be of mechanical or inflammatory origin or, in some rare cases, remain unexplained.     

Pneumatosis intestinalis in the adult: benign to life-threatening causes

OBJECTIVE: The frequency of detection of pneumatosis intestinalis (PI) appears to be increasing. This increase may be the result of increased CT use. New medications and surgical procedures have been reported to be associated with an increase in the incidence of PI. The purpose of this review is to provide an update on the imaging features and clinical conditions associated with PI. CONCLUSION: This article illustrates the imaging findings of PI due to benign and life-threatening causes, with emphasis placed on describing newly associated conditions and also the imaging appearance on CT.     

小肠坏死的CT特点

目的 探讨小肠坏死的CT表现特点.方法 对16例小肠坏死的平扫CT图像和临床资料进行回顾性分析,评价小肠坏死的CT特征.结果 16例小肠坏死CT平扫表现为肠腔不同程度扩张、积气及肠间、肠壁积气,同时伴肝内胆管和血管积气9例;小肠肠腔扩张、积液7例,其中1例伴有漩涡征,2例扩张肠腔内伴有气-液平;16例患者均有不同程度的腹腔或肠间隙积液及肠系膜脂肪密度增高.结论 小肠坏死CT表现具有特征性.     

64层螺旋 CT 三维重建在腹部寄生胎中的诊断应用

目的：探讨64层螺旋C T三维重建（3D ）在腹部寄生胎中的诊断价值。方法回顾性分析经手术病理证实的15例腹部寄生胎患者的临床及C T影像资料,15例均行64层螺旋C T平扫及三维重建。结果15例中,女性9例,男性6例,年龄1个月10天～60岁。肿块位于腹膜后8例,腹腔内7例。C T 横断面表现为混杂密度肿块,境界清楚,内见轴骨系统、脂肪密度、软组织密度等结构,邻近组织脏器受压、移位,肠管积气。冠状面及矢状面最大密度投影（M IP ）清晰显示肿块内脊椎骨、四肢骨及肋骨等骨性结构,容积再现（V R ）完整显示寄生胎内骨性结构全貌。结论64层螺旋C T 平扫及三维重建技术是一种快速、准确、可靠的检查方法,能为临床医师提供直观、真实可靠的影像学诊断依据,可作为腹部寄生胎患者的首选影像学检查手段。     

胃癌的CT诊断及分期

目的：描述胃癌的CT表现，评价胃癌术前CT分期的准确性，以总结CT在胃癌诊断中的应用价值．材料和方法：口服水对比剂充盈胃增强CT扫描．检查已知胃癌病者56例，并将CT发现与手术病理进行对照．结果：胃癌灶在CT上表现为胃壁增厚(38／55)，软组织肿块(17／55)及异常强化(48／55)。本组CT术前分期总的准确性为81．8％，胃癌可切除性术前估价准确性为89%。结论：CT检查在胃癌的检出及术前分期等方面具有较大的实用价值．     

螺旋CT在进展期胃癌诊断中的价值探讨

目的：探讨螺旋CT在进展期胃癌诊断中的应用价值及相关技术要点。方法：回顾性分析经手术及／或病理证实的进展期胃癌48例螺旋CT图像，其中12例作多平面重建(MPR)。将手术结果与螺旋CT表现进行比较。结果：螺旋CT对进展期胃癌的检出率为100％，定性准确率97．9％；螺旋CT对胃癌向邻近组织侵犯诊断准确率为81．8％，对腹部脏器转移诊断准确率为100％；对淋巴结转移诊断准确率为73．3％。结论：螺旋CT扫描能明确进展期胃癌的诊断，清晰显示胃癌向邻近组织的侵犯及腹腔内转移灶，对临床治疗有指导作用。     

Intestinal ischemia: comparison of plain radiographic and computed tomographic findings

This article illustrates the radiographic and CT findings in 14 patients with proved intestinal ischemia or infarction. Gaseous bowel distention, thumbprinting and pneumatosis were the most frequent radiographic findings; intestinal distention, thickening of the bowel wall, engorgement of mesenteric vessels, and pneumatosis, the most frequent CT findings. The authors conclude that CT offers major advantages for evaluating patients suspected of having intestinal ischemia or infarction.     

产气法CT仿真内窥镜在胃癌诊断中的应用探讨

目的探讨产气法螺旋CT仿真内窥镜及其各种三维重建技术在胃癌诊断的应用价值。方法收集整理我院经手术和病理证实的31例胃癌患者的病例资料,进行回顾性研究探讨。结果 CT仿真内窥镜(CTVG)检查对胃癌多能明确诊断,其检出率和准确率较高。结论产气法CT仿真内窥镜及其各种三维重建检查技术获取的图像不仅能清晰观察胃壁及胃腔内外的病变,而且能非常直观、立体地观察胃癌大体形态及肿瘤的范围,它对胃癌的定位、定性、定量诊断有独特的应用价值。     

Pneumatosis intestinalis and portomesenteric venous gas in intestinal ischemia: correlation of CT findings with severity of ischemia and clinical outcome.

OBJECTIVE: The purpose of this study was to analyze the correlation between pneumatosis or portomesenteric venous gas, or both, the severity of mural involvement, and the clinical outcome in patients with small- or large-bowel ischemia. MATERIALS AND METHODS: CT scans of 23 consecutive patients presenting with pneumatosis or portomesenteric venous gas caused by bowel ischemia were reviewed. The presence and extent of both CT findings were compared with the clinical outcome in all patients and with the severity and extent of ischemic bowel wall damage as determined by surgery (15 patients), autopsy (three patients), or follow-up (five patients). RESULTS: Seven patients showed isolated pneumatosis, and 16 patients showed portomesenteric venous gas with or without pneumatosis (11 and five patients, respectively). Pneumatosis and portomesenteric venous gas were associated with transmural bowel infarction in 14 (78%) of 18 patients and 13 (81%) of 16 patients, respectively. Nine patients (56%) with portomesenteric venous gas died. Of seven patients with infarction limited to one bowel segment (jejunum, ileum, or colon), only one patient (14%) died, whereas of the 10 patients with infarction of two or three bowel segments, eight patients (80%) died. CONCLUSION: CT findings of pneumatosis intestinalis and portomesenteric venous gas due to bowel ischemia do not generally allow prediction of transmural bowel infarction, because they may be observed in patients with only partial ischemic bowel wall damage. The clinical outcome of patients with bowel ischemia with these CT findings seems to depend mainly on the severity and extent of their underlying disease.