J Korean Soc Radiol.  2019 Mar;80(2):274-282. 10.3348/jksr.2019.80.2.274.

Pneumatosis Intestinalis Associated with Pulmonary Disorders

• Ko Y
• Shim SS
• Kim Y
• Chang JH

• KMID: 2442518
• DOI: http://doi.org/10.3348/jksr.2019.80.2.274

Abstract

PURPOSE
To determine the clinical features, imaging findings and possible causes of pneumatosis intestinalis (PI) in thoracic disorder patients.
MATERIALS AND METHODS
From 2005 to 2017, Among 62 PI patients, four of PI related with thoracic disease (6%) were identified. Medical records were reviewed to determine the clinical presentation, laboratory findings and treatment at the time of presentation of PI. Two experienced chest radiologists reviewed all imaging studies and recorded specific findings for each patient.
RESULTS
The causative thoracic diseases for each four patient were severe asthma, emphysema and airway obstruction. The imaging appearance of PI, including the involved bowel segment and pattern of the air, were divided into two mesenteric vascular territories; three of our cases showed linear pattern of PI located in the ascending & proximal transverse colon and the fourth case (lung cancer) had bubbly and cystic PI in the distal transverse and descending colon. All of the remaining 3 patients, except one patient who had not been followed up, improved within 1 month by conservative treatment.
CONCLUSION
Thoracic disorder with obstructive lung disease may result in the development of benign PI. Such PI in thoracic disease patients has a similar linear and cystic appearance with ischemic bowel disease, but can nevertheless be managed by conservative treatment.

MeSH Terms

Airway Obstruction
Asthma
Colon, Descending
Colon, Transverse
Emphysema
Humans
Lung Diseases, Obstructive
Medical Records
Pneumatosis Cystoides Intestinalis
Thoracic Diseases
Thorax

Figure

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  Fig. 1. A 43-year-old woman with severe asthma. A. Chest X-ray posterior-anterior views shows pneumomediastinum (arrows) with PI (arrowheads) on initial chest radiography. B. These lesions are completely resolved after 1 month with conservative treatment. C, D. Transverse and coronal abdomen CT scans (2.0-mm slice thickness) obtained with lung and wide window show linear patterns of PI involving from the cecum to proximal transverse colon.

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  Fig. 2. A 79-year-old man with lung cancer. A. Chest X-ray posterior-anterior views shows decreased volume of left lung with mass and a nodule in right lower lung zone. B. Transverse contrast-enhanced CT scan obtained with mediastinal window shows a large necrotic mass causing nearly complete stenosis of left main bronchus (arrow). C. Coronal chest CT scan obtained with lung setting shows cystic and bubbly appearance of pneumatosis intestinalis involving distal trans-

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  Fig. 3. A 71-year-old man with choking by food material and aspiration pneumonia. with residual food and mucoid impaction in the left main bronchus. B, C. Transverse and coronal abdomen CT scan with bone window shows a linear pattern of pneumatosis intestinalis in the ascending colon. A. Transverse chest CT scan obtained with lung window taken after removal of aspirated food material shows atelectasis of left lower lobe

Reference

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