Pneumotosis - Answer Case 2 6/14/2009

In this image, there is air outlining the wall of large bowel. This reflects pneumotosis intestinalis. The differential for this process is long.

DDx
1. Mesenteric ischemia/infarction.
2. Necrotizing enterocolitis
3. Post anastomosis
4. Intestinal obstruction/volvulus
5. Gastric, duodenal ulcers
6. Perforation of diverticulum
7. Pseudomembranous colitis
8. Post endoscopy and post trauma
9. COPD
10. Steroids
11. Collagen vascular disease
12. Mesenteric abscess
13. Neoplastic bowel wall damage

Therefore, the key is to know the patient's history and clinical scenario. This turned out to be a benign pneumotosis.

reference - http://www.ajronline.org/cgi/content/full/177/6/1319; uhrad; http://radiographics.rsnajnls.org/cgi/content/full/22/5/1093