PMC6159274_01
Case 1. A 56-year-old female with metastatic (liver, bones and brain) breast cancer receiving systemic chemotherapy plus corticosteroids. Restaging body CT scan, coronal (a) and axial (b) reformatted images; lung window. There is a moderate amount of pneumatosis in the mesentery and pericolic fat , and intramural gas along the caecum, ascending colon and a short section of the transverse colon. Bowel walls are not thickened or distended, haustra are regular and mesenteric vessels are patent. A plain abdominal film (c) taken 5 days later shows persistent asymptomatic pneumatosis.
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CT examination revealed a moderate amount of pneumatosis in the mesentery and pericolic fat, and intramural gas along the caecum and ascending colon (Figure 1), with the absence of other worrisome CT findings.
PMC6159274_02
Case 2. A 52-year-old female with metastatic (lymph nodes, bone and brain) breast cancer, receiving chemotherapy and corticosteroids, submitted to body CT scan to rule out abdominal injury; axial CT image (detail of transverse colon), lung window. The image shows a moderate amount of intramural gas involving the caecum, ascending and transverse colon, with an extensive amount of gas in the mesenteric and pericolic fat; haustra are regular.
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On clinical examination, there were no signs of peritonism or sepsis, hence the surgical consultant recommended close conservative observation with supportive care alone. 5 days later, a follow-up CT scan of the abdomen showed an increase in the amount and extent of PI (Figure 2).
PMC6159274_03
Case 3. An 80-year-old male receiving chemotherapy for lung adenocarcinoma and corticosteroids for chronic obstructive pulmonary disease-related dyspnoea. Chest CT; axial image, lung window. (a) Incidental finding of a large amount of gas in the adipose tissue along the caecum, and ascending and transverse colon; minimal intramural gas is confined to the caecum. The wall thickness is normal and haustra are regular. (b) Abdominal plain film performed a week later: persistence of a conspicuous amount of extravisceral gas along the caecum, right and transverse colon; no evidence of visceral distension.
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A CT scan of the chest performed to evaluate worsening cough and dyspnoea showed a large amount of gas in the adipose tissue along the caecum, and the ascending and transverse colon (Figure 3a). An abdominal plain film (Figure 3b) taken a week later documented the persistence of PI along the right and transverse colon.
PMC6159274_04
Case 4. A 57-year-old female receiving chemotherapy, including cetuximab after surgery, and radiotherapy for colorectal cancer. Restaging total-body CT scan; coronal oblique reformatted image; lung window. Moderate amount of intramural gas involving the caecum and ascending colon with the absence of pathological wall dilatation or thickening.
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A subsequent restaging total-body CT scan showed moderate PI involving the caecum and the ascending colon (Figure 4) in the absence of other gastrointestinal worrisome findings.