Why so much gas? Air inclusion in the liver: from the common to the rare

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Congress:

ECR 2017

Poster Number:

C-0981

Type:

Educational Exhibit

Keywords:

Education, CT, Liver, Abdomen, Infection, Ischaemia / Infarction

Authors:

A. Ferrari¹, F. Schirru², F. lavra³, M. Porcu³, L. Casciu³, A. Balestrieri³, L. Saba³; ¹Monserrato/IT, ²Nurri/IT, ³Cagliari/IT

DOI:

10.1594/ecr2017/C-0981

DOI-Link:

https://dx.doi.org/10.1594/ecr2017/C-0981

Fig. 1: Possible causes of hepatic gas

Fig. 2: 65 y.o man with acute emphysematous cholecystitis. (a-d) Unenhanced CT...

Fig. 3: 82 y.o woman whit acute abdominal pain. (a) CT scan shows gas collection in...

Fig. 4: 55 y.o man with fever who underwent Cholecistectomy and sphincterectomy 6...

Learning objectives

To review different causes of liver air inclusion; to learn the CT findings of each pathology; to show the differential diagnosis between them.

Background

The presence of gas in the liver is often associated with potentially fatal conditions. First studies in literature correlated this condition to a variable mortality, between 75% and 80%; more recent studies have reviewed these statistics, evaluating a percentage of about 25% of exitus. This may be due to the higher incidence of iatrogenic causes (usually associated with lower mortality), to an earlier diagnosis based on the observation of small bubble gas in the liver by CT and US and to improved therapies. Wolfe and...

Findings and procedure details

NONIATROGENIC CAUSES OF PNEUMOBILIA EMPHYSEMATOUS CHOLECYSTITIS Emphysematous cholecystitis is a rare form of acute cholecystitis, often associated with acalculous cholecystitis and perforation of the gallbladder. Men are affected twice than women, with a mean age of incidence around 50-70 years. Often it correlates to diabetes and atherosclerotic disease; therefore the occlusion of cystic artery is considered a major cause of evolution towards the emphysematous form. The most commonly involved bacteria belong to the family of Clostridium and Escherichia. Clinically the onset is quite insidious and...

Conclusion

The presence of air in liver needs, in first instance, a correct localization, differentiating between blood vessels, biliary ducts and parenchyma. It is then necessary a proper clinical assessment and medical history which, together with the CT aspects, allow a correct diagnosis.

Personal information

References

Liebman PR, Patten MT, Manny J, Benfield JR, Hechtman HB. Hepatic--portal venous gas in adults: etiology, pathophysiology and clinical significance. Ann Surg. 1978 Mar;187(3):281-7. Cambria RP, Margolies MN. Hepatic portal venous gas in diverticulitis: survival in a steroid-treated patient. Arch Surg. 1982 Jun;117(6):834-5. Benson MD. Adult survival with intrahepatic portal venous gas secondary to acute gastric dilatation, with a review of portal venous gas. Clin Radiol. 1985 Jul;36(4):441-3. Faberman RS, Mayo-Smith WW. Outcome of 17 patients with portal venous gas detected by CT. AJR Am...