Presentation
The patient was admitted to A&E for pleuritic chest pain suspected to be due to a pneumothorax. Patient is an intravenous drug user.
Patient Data
Consolidation at the right lower zone, suspicious for infection. A repeat six-week follow-up chest x-ray was recommended.
However, two other abnormalities were shown on this radiograph but were not reported initially.
There is a small focus of crescent-shaped air beneath the right hemidiaphragm, suggestive of subdiaphragmatic free gas.
Additionally, on further review, there are multiple small radiolucent cyst-like structures beneath the left hemidiaphragm, which are of uncertain etiology on plain film imaging.
These features should have prompted further investigation with CT.
There has been resolution of the previously demonstrated infective change at the right lower zone.
No further comment was made in the report.
The subdiaphragmatic free gas seen beneath the right hemidiaphragm has disappeared.
There still appears to be a cystic appearance of the bowel in the region of the splenic flexure, which was not commented upon.
There is evidence of multiple air lucencies within the colonic wall predominantly in the hepatic flexure, in keeping with pneumatosis cystoides coli. There is associated small-volume pneumoperitoneum.
On retrospective review of the chest radiograph, there is pneumatosis coli in the left upper abdomen, indicating a benign longstanding abnormality.
Case Discussion
Pneumatosis cystoides coli is likely due to benign abnormalities seen in pulmonary disease, systemic disease (scleroderma, lupus), HIV infections, drug and transplant-related.
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