Portal gas in a patient with acute obstructive cholangitis: report of a case with emphasis on US findings

The role of different ultrasound modes in hepatic portal venous gas diagnosis, including a novel method using color M-mode

Hepatic portal venous gas (HPVG) indicates an abnormal gas buildup within the portal venous system, associated with severe medical conditions. Causes include heightened intraluminal pressure, bowel wall disruption, bowel necrosis, and pathogenic bacteria. Previously considered indicative of extensive bowel necrosis requiring surgery, HPVG is now recognized in non-surgical conditions, posing diagnostic challenges. Doppler-coupled sonography, particularly sensitive for HPVG detection, serves as a valuable initial screening tool. This article synthesizes findings from ultrasound methods for assessing portal venous gas reported in the literature and introduces a new approach using Color M-mode ultrasound.

Portal Venous Gas Secondary to Gangrenous Gallbladder and Mirizzi Syndrome Diagnosed by Gray-Scale Sonography but Not on 64-Slice MDCT: A Case Report and Literature Review

Portal venous gas is a rare entity that is associated with many fatal and nonfatal conditions. Its exact etiology remains unclear. Computed tomography (CT) has been described as a sensitive and primary imaging tool for detecting this condition, but there are only a few case reports in the literature where portal venous gas was not detected on CT scan but was found by sonography. This case reports portal venous gas developing secondary to gangrenous gallbladder with Mirizzi syndrome which was diagnosed by sonography but remained undetected on 64-slice MDCT.

Portal gas in a diabetic patient under pharmacotherapy with an alpha-glucosidase inhibitor: report of a case with emphasis on US findings

Portal gas is relatively rare, and its relation to ischemic bowel diseases has been emphasized. We report the case of a 56-year-old diabetic man under pharmacotherapy with an alpha-glucosidase inhibitor in which portal gas was incidentally detected by ultrasound (US). It showed multiple echo spots moving in the portal vein. Doppler signals confirmed them to be bidirectional and spiky, which immediately led to the diagnosis of portal gas. A change in oral antidiabetic drug caused the portal gas to disappear. We stress the usefulness of US and Doppler US for detecting and diagnosing portal gas. Although detailed analysis of a larger series of diabetic patients under this therapy is needed to draw a definitive conclusion, our observation merits attention. We also briefly review the literature.

Asymptomatic emphysematous cholecystitis

Emphysematous cholecystitis (EC) is a life-threatening complication of acute cholecystitis. Its clinical manifestations are usually vague, but asymptomatic cases are very rare. We present such a case with an emphasis on sonographic (US) findings. In this case, detection of gas echoes in the gallbladder wall and the surrounding hepatic tissue led us to an appropriate treatment. US is now the technique of first choice for diagnosing gallbladder diseases, and knowledge of US findings encountered in this case can help prevent a hazardous delay in emergent treatment.

Flaming portal vein as a new color Doppler sign of portal gas: report of two cases

Portal gas is relatively rare, and the majority of reported cases have shown it to have a close relation to bowel diseases. At present, portal exploration usually begins with color Doppler sonography, and clinicians now possess a good understanding of color Doppler findings of a wide spectrum of portal abnormalities. However, the color Doppler sign we present in this article has not been reported before. We report two cases of ischemic bowel disease in which B-mode ultrasound showed multiple hyperechoic spots moving in the portal vein; the color Doppler appearance was as if the portal vein was on fire (flaming portal vein sign). Knowledge of this simple color Doppler sign helps to improve the diagnostic strategies in patients with portal gas.