Pneumatosis
Eva Ilse Rubio, MD
DIFFERENTIAL DIAGNOSIS
Common
Necrotizing Enterocolitis
Neutropenic Colitis
Less Common
Steroid Use
Rotavirus, Other Infection
High Intrathoracic Pressures
Asthma
Cystic Fibrosis, Lung
High Ventilator Pressures
Post-Surgery/Post-Endoscopy
Idiopathic
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Does the child appear toxic or well?
Concurrent medical/surgical history
Helpful Clues for Common Diagnoses
Necrotizing Enterocolitis
Most common in premature infants
Others at risk include those with congenital heart disease, indomethacin therapy, perinatal asphyxia
Progresses over short period of time
Normal bowel gas pattern → elongated distended loops → pneumatosis ± portal venous gas &/or pneumoperitoneum
Radiographs
Fine linear arrays of air within wall when seen on edge
Foamy appearance when seen en face, sometimes difficult to distinguish from normal stool
Ultrasound
Thickened walls, poor peristalsis
Intramural air may be seen
Neutropenic Colitis
High risk groups include those with acute lymphocytic leukemia, acute myelogenous leukemia, bone marrow transplant recipients
Can involve any segment of small bowel or colon: Proclivity for right colon; cecum most commonly involved
Commonly accepted etiology: Breakdown of bowel mucosa with bacterial infiltration
CT findings
Bowel wall thickening with pneumatosis
Inflammatory stranding, ascites
Helpful Clues for Less Common Diagnoses
Steroid Use
Used by patients with asthma, cystic fibrosis, inflammatory/autoimmune disorders; ask clinician
Rotavirus, Other Infection
None of above comorbidities; positive stool culture
High Ventilator Pressures
May be either benign pneumatosis intestinalis or incipient bowel necrosis in ICU patients
