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

Abstract

Portal gas is relatively rare, and its relationship to ischemic bowel diseases has been emphasized. We report the case of a 70-year-old woman with acute obstructive cholangitis in whom portal gas was detected by ultrasonography (US) but not by computed tomography (CT). The former 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. Immediate appropriate antibiotic treatment and biliary drainage yielded the disappearance of the portal gas. We stress the usefulness of US and Doppler US for detecting and diagnosing portal gas. Our observation suggests that when portal gas is detected by US, the possibility of cholangitis should be included in the differential diagnosis.

Asymptomatic emphysematous cholecystitis

“…As has been reported in the literature [7,8], US is considered to be more sensitive than CT in the detection of very small amounts of gas. In fact, in our case, gas extending to the liver was easily detected by US, but there were no correlative CT findings.…”

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

“…Second, it compromises the linearity of the frequency analyzer and displays an artifactual vertical linear waveform (apparently composed of a wide range of frequencies). As has been stressed in the literature, US is considered to be more sensitive than CT for the detection of very small amounts of portal gas, and the final diagnosis of portal gas is now believed be made based on US findings alone [9,31]. Recently, Ijuin et al reported two cases of portal gas in which color Doppler US was useful in the diagnosis.…”

“…However, the concept of portal gas changed over time [13,15,19]. As experience with noninvasive medical imaging of the abdomen has accumulated, it has become apparent that it occurs following Crohn's disease [19], ulcerative colitis [19], diverticulitis [17], enteritis [17,20,27], blunt abdominal trauma [15], gastric ulcer [19], intra-abdominal abscess [12,18], lumbar puncture [25], transplant rejection [6,7], and cholangitis [5,[9][10][11]31]. To our knowledge, there are no previous reports of portal gas due to alphaglucosidase inhibitors in the English-language literature.…”

“…Regardless of the causal disease, the US findings of portal gas are (a) presence of high-echo spots flowing with the portal vein (B-mode) and (b) sharp, bidirectional, spiky waveform obtained from these echo spots (FFT) [6,9,10,15,21,22,[30][31][32].…”

“…Portal gas is a relatively rare pathologic condition following a wide spectrum of clinical causes [31][32][33], but there is a marked paucity of information on portal gas encountered in diabetic patients under pharmacotherapy with an alpha-glucosidase inhibitor.…”