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Necrotizing Enterocolitis - Portal Venous Gas

Case Detail

Anatomy: Gastrointestinal
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US
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1 week old premature newborn with abdominal distention and feeding intolerance.

Case Images


Necrotizing Enterocolitis


US – Numerous punctate intraportal echogenicities confirmed to be gas on spectral Doppler as intermittent sharp spikes.


Necrotizing enterocolitis is likely secondary to infection, intraluminal contents, immature immunity, release of vasoconstrictors, and inflammatory mediators. The loss of mucosal integrity allows passage of bacteria and their toxins into the bowel wall and then into the systemic circulation, resulting in a generalized inflammatory response and overwhelming sepsis.

The diagnosis of portal venous gas in neonates with necrotizing enterocolitis is associated with high mortality. The pathogenesis of portal venous gas is not fully understood. Mucosal damage followed by bowel distention allows intraluminal gas to enter the portal venous system. Alternatively mucosal injury may permit mural migration of gas forming bacilli. Intramural gas then decompresses into the portal venous system.

Portal venous gas is diagnosed as flowing intraluminal echogenic foci in the portal veins. Doppler interrogation shows sharp bidirectional spikes of Doppler shift superimposed on the portal venous waveforms. Gas in peripheral portal branches may form linear and branching echogenicities. Portal gas is more often seen in the non-dependent hepatic segments.


Silva CT, Daneman A, Navaro OM, et al. Correlation of sonographic findings and outcome in necrotizing enterocolitis. Pediatric Radiol (2007); 37:274-282.

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