Pneumatosis intestinalis CT

• CT is the most sensitive imaging test for identification of PI.
• On both radiographs and CT, PI usually appears as a low-density linear or bubbly pattern of gas in the bowel wall. It can be a combination of both linear and bubbly bowel-wall gas. There also may be circular collections of gas in the bowel wall.
• Viewing CT images with lung windows may accentuate the detection of PI, especially in the colon.
• Circular form of PI is usually benign and most often seen with pneumatosis cystoides intestinalis (PCI).
• Linear or bubble-like PI can be due to both benign and life-threatening causes, and its radiographic or CT appearance alone does not allow differentiation between them.
• The presence of additional findings such as bowel wall thickening, absent or intense mucosal enhancement, dilated bowel, arterial or venous occlusion, ascites, and hepatic portal or portomesenteric venous gas increases the possibility of PI due to a life-threatening cause.
• PI that is confined to a portion of the small or large bowel within a specific vascular distribution also increases the likelihood that ischemia is the cause of PI.
• Intraperitoneal or retroperitoneal free air can be seen with PI due to life-threatening or benign causes.

Shown below are the CT images in pneumatosis intestinalis.

Images courtesy of RadsWiki

Images courtesy of RadsWiki

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