Pneumatosis

Contributed by: Ed Boas

Clinical history: 75 year old woman with esophageal squamous cell carcinoma, status post Ivor-Lewis esophagectomy.  She now returns with pain around her jejunostomy tube.

Findings: CT shows extensive pneumatosis from the ileum to the descending colon, as well as pneumoperitoneum and portal venous gas.  Also note the esophageal stent, which was placed to control an esophagopleural fistula.  Thick enhancing left pleura is consistent with empyema.

Discussion:

Pneumatosis can be seen with ischemic bowel, which has a high mortality rate.

Pneumatosis also can have a benign etiology, due to air dissecting through the bowel wall, which can be seen with COPD, mechanical ventilation, endoscopic procedures, and jejunostomy tubes.

In this case, the patient was clinically doing well, and the lactate level was normal, which both argue against ischemic bowel.  On follow up, the pneumatosis resolved.