Brief Clinical Observation
Pneumatosis cystoides intestinalis: Imaging findings with colonoscopy correlation

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Abstract

We report on a case of pneumatosis cystoides intestinalis in a 32-year-old woman affected by coeliac disease with stool cultures positive for salmonella. After plain film of the abdomen, patient underwent computed tomography and magnetic resonance colonography studies that demonstrated numerous, diffuse bubblelike intramural gas collections into the ascending, transverse and descending colonic wall. CT and MR findings were correlated with colonoscopy.

Introduction

Pneumatosis intestinalis is a radiological finding due to the presence of subserosal or submucosal gas-filled cysts in the gastrointestinal tract. Intramural gas collections may have cystic, bubbly, curvilinear or linear appearance and are usually found along the mesenteric side of the bowel [1]. Pneumatosis intestinalis is often identified on abdominal radiographs; however, computed tomography (CT) or magnetic resonance (MR) imaging may confirm the diagnosis, give some additional informations and help in determining the primary cause or some possible coexistent complications.

We report on a case of pneumatosis cystoides intestinalis studied with both CT colonography and MR colonography and illustrate their typical findings with colonoscopy correlation.

Section snippets

Case report

A 32-year-old woman affected by coeliac disease (diagnosed 9 years before) was admitted to our hospital with diarrhoea alternating with smelly and more solid stool, fever and abdominal pain. Routine laboratory tests were negative; stool cultures were positive for salmonella. Plain film of the abdomen was first performed and revealed multiple radiolucent cystic collections of gas located along the large bowel (Fig. 1). In the suspicion of pneumatosis intestinalis, the patient subsequently

Discussion

Pneumatosis intestinalis is defined, since 1946 by Lerner and Gazin, as “the presence of gas in an abnormal site of the body” [2]. It is an imaging sign, not a diagnosis, characterized by the presence of subserosal or submucosal gas-filled cysts in the gastrointestinal tract, ranging in size between a few millimeters and more than 1 cm. Pneumoperitoneum and pneumoretroperitoneum can be rare complications due to rupture of the cysts.

Pneumatosis intestinalis occurs in two main forms. The primary

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