A case of portal venous gas secondary to acute appendicitis detected on gray scale sonography but not computed tomography

Abstract

The presence of portal venous gas (PVG) has been reported most often in association with bowel ischemia or infarction but may result from nonischemic conditions such as bowel trauma or surgery, inflammatory or tumoral ulcerative disease, or infectious or inflammatory bowel disease. In a setting of mesenteric infarction, the presence of PVG has been reported to be an ominous finding; however, when PVG is related to nonischemic conditions, clinical outcome seems to be determined by the underlying disease and not by the presence of PVG. Therefore, diagnosis of PVG is of clinical importance because quick medical or surgical treatment of the underlying condition may be warranted. Both computed tomography (CT) and gray scale or Doppler sonography contribute to the detection of PVG, with CT being more sensitive in identifying the underlying cause of PVG. Recent reports suggest that sonography may be more sensitive in detecting PVG than CT. We report a case of PVG detected on gray scale sonography that went undetected on CT. The cause of PVG in this case was acute appendicitis, which to our knowledge has never been reported in the literature. © 2005 by the American Institute of Ultrasound in Medicine.