Emphysematous conditions of the abdomen and pelvis: pearls and pitfalls

Abstract

Emphysematous conditions of the abdomen and pelvis are uncommon but are potentially lethal. A majority of these share common predisposing risk factors such as uncontrolled diabetes mellitus, immunocompromised states, chronic kidney disease, hepatic cirrhosis, malignancy, chemotherapy, and polytrauma. Computed tomography is the most utilized modality for the evaluation of emphysematous conditions in an emergency scenario. It is equally important to recognize mimics of the lethal emphysematous pathologies to avoid misdiagnosis. Gas-containing imaging mimics occur due to recent interventions, instrumentation, and fistulae. This review discusses the pertinent clinical and imaging features of emphysematous conditions of the abdomen and pelvis that can help confirm the diagnosis and guide patient management. For each of these emphysematous pathologies, we also discuss various gas-containing imaging mimics, as the management of these mimics differs from true emphysematous pathologies.