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Review
. 2012 May;81(2):74-8.

Hepatic portal venous gas--three non-fatal cases and review of the literature

Kevin McElvanna  1 , Alastair Campbell, Tom Diamond
Affiliations
Review

Hepatic portal venous gas--three non-fatal cases and review of the literature

Kevin McElvanna et al. Ulster Med J. 2012 May.

Abstract

Background: Hepatic portal venous gas is a rare imaging finding most commonly associated with intestinal ischaemia and high mortality. Increased use of advanced imaging techniques has resulted in increased reporting and recognition of hepatic portal venous gas. Advanced imaging can also recognise the many associated pathologies which have variable management strategies and prognoses.

Methods: We report 3 non-fatal cases and review the pathogenesis, aetiology, diagnosis, management and prognosis of hepatic portal venous gas.

Conclusion: Once considered an indication for urgent surgery, hepatic portal venous gas is a rare imaging finding. More recently, HPVG has been recognised to be associated with various benign causes many of which may be treated non-operatively. However, intestinal ischaemia remains the most common cause and the most important to exclude. CT is the diagnostic modality of choice. The underlying cause determines the treatment strategy and outcome.

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Figures

Fig 1
Fig 1
Multiple non-shadowing echogenic foci consistent with intrahepatic portal venous gas.
Fig 2
Fig 2
Branching low-attenuation areas within 2cm of the left hepatic lobe capsule in keeping with HPVG (red). Markedly distended and fluid-filled stomach (S).
Fig 3
Fig 3
Intra-abdominal haematoma (H). Linear gas collections (yellow) within the gastric wall consistent with gastric pneumatosis. HPVG in the anterior periphery of the left lobe (red) .Gas within the medial gastric wall (yellow).
Fig 4
Fig 4
a. Gas and thrombus in the portal vein (PV) b. Gas in the inferior mesenteric vein (IMV)
Fig 5
Fig 5
HPVG in the superior periphery of the right hepatic lobe.
None
None
See this image and copyright information in PMC

References

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