PMC9427313_01
POCUS and CTA of case 1. (a) POCUS shows portal vein at hepatic hilum (asterisk) with multiple hyperechogenic spots into the lumen. White arrows indicate air in intrahepatic portal vessels with altered liver ultrasonographic structure. (b) A CTA scan confirms air into the liver (white arrows), while air is not easily identified into portal vein. (c) CTA confirms a little area of pneumatosis intestinalis (white arrow). POCUS stands for point-of-care ultrasonography; CTA stands for computed tomographic angiography.
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fig1
POCUS showed an altered liver ultrasound pattern due to massive air infiltration in the portal system and portal vein showed a spontaneous echo-contrast with multiple hyperechoic spots flowing in the lumen suggestive of PVG (Figure 1(a)). We immediately performed a CTA that confirmed intestinal pneumatosis and diffuse air in the hepatic parenchyma (Figures 1(b) and 1(c)).
PMC9427313_02
POCUS and CTA of case 2. (a) POCUS shows a right portal branch (asterisk) with some air bubbles into the lumen (black arrow). White arrows indicate some air in intrahepatic portal vessels. (b) CTA showing pneumatosis intestinalis (white arrow). (c) CTA shows the air flowing within the intestinal vessels (white arrow), as it is drained from the pneumatosis intestinalis, that will reach the portal vein. POCUS stands for point-of-care ultrasonography; CTA stands for computed tomographic angiography.
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fig2
Ultrasonography showed multiple hyperechogenic spots in the portal vein with altered liver ultrasonographic structure by diffuse air infiltration, compatible with PVG (Figure 2(a)). A CT angiography confirmed left colon pneumatosis and air in liver parenchyma (Figures 2(b) and 2(c)).
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