PMC4515940_01
Ultrasonography of the liver, subcostal view, showing the gall bladder (white arrowhead), the plane dividing the liver into the right and left lobe. Note the poorly defined, highly echogenic foci (black arrowheads) confined only to the left lobe of the liver with sparing of the right lobe, suggestive of isolated left hepatic portal venous gas.
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However, to our surprise, those echogenic foci were confined only to the left lobe of the liver with sparing of the right lobe (Figure 1).
Axial CT scan of the chest shows the location of the stomach in the posterior mediastinum, behind the heart, anterior to the spine and aorta with accompanying abdominal fat suggestive of diaphragmatic hernia. Note the presence of air specks within the gastric wall (white arrowheads) indicative of gastric pneumatosis.
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A non-enhanced computed tomography of the chest and abdomen showed a grossly distended stomach with intrathoracic extension of the stomach in the posterior mediastinum located behind the heart and anterior to the spine and aorta suggestive of a diaphragmatic hernia, with intramural gas in the stomach wall indicative of incarceration and resultant gastric pneumatosis (Figure 2).
Axial CT scan of the upper abdomen confirms the presence of isolated left hepatic portal venous gas (white arrowheads). Sparing of the right lobe is seen (single white broad arrow). Note the associated gastric pneumatosis depicted in the upper abdominal sections (multiple white thin arrows).
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Isolated left hepatoportal gas was confirmed by the presence of low-attenuation hypodensities extending from the porta to within 2 cm of the liver peripheral margin but located only in the left lobe of the liver (Figure 3).
Image showing normal porto-venous drainage of the left gastric vein at the confluence of the superior mesenteric vein and the splenic vein. Note the aberrant left gastric vein draining into the left portal vein.
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This aberrant vein draining the lower part of the oesophagus and the upper part of the stomach joins the left portal vein rather than the main portal vein giving rise to isolated left hepatic portal venous gas (Figures 4, 5).
Axial CT scan of the upper abdomen showing gastric pneumatosis depicted in the abdominal sections (white solid arrows).
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This aberrant vein draining the lower part of the oesophagus and the upper part of the stomach joins the left portal vein rather than the main portal vein giving rise to isolated left hepatic portal venous gas (Figures 4, 5).