Portal venous gas on ultrasound

Case contributed by Jayanth Keshavamurthy
Diagnosis certain


Clinical statement: abdominal pain with elevated GGT/ALP.

Patient Data

Age: 50
Gender: Male

Echogenic foci and reflectors in portal vein from gas in portal vein on color Doppler as pathognomonic of portal venous gas.


Small bowel obstruction with pneumatosis intestinalis and portal venous gas, findings concerning for bowel ischemia. Further evaluation with CT abdomen pelvis is recommended.

  1. Findings remain consistent with small bowel obstruction with abrupt transition in bowel caliber within the right hemiabdomen at the level of the mid ileum. Overall degree of bowel distention has increased since study 3 days prior.
  2. There has been interval development of diffuse pneumatosis intestinalis beginning at the level of the ligament of Treitz and continuing throughout the jejunum and proximal ileum to the point of bowel caliber transition in the right hemiabdomen. This is highly concerning for bowel ischemia/infarction. Gas is identified within the mesenteric veins within the upper abdomen along with portal venous gas.

Case Discussion

Findings in operation: single band in ileum with complete bowel obstruction. At the site of the band was an ischemic segment of bowel. Diffuse pneumatosis intestinalis but remaining bowel appeared viable. Massive proximal distension. Blood tinged ascites.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.