Sebastià C, Quiroga S, Espin E, Boyé R, Alvarez-Castells A, Armengol M
Departments of Radiology I.D.I, Hospital General Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, Barcelona 08015, Spain.
Radiographics. 2000 Sep-Oct;20(5):1213-24; discussion 1224-6. doi: 10.1148/radiographics.20.5.g00se011213.
Portomesenteric vein gas is a rare condition whose pathogenesis is not fully understood. Portomesenteric vein gas is most commonly caused by mesenteric ischemia but may have a variety of other causes. The primary factors that favor the development of this pathologic entity are intestinal wall alterations, bowel distention, and sepsis. Portomesenteric vein gas is idiopathic in approximately 15% of cases. Advanced imaging techniques such as computed tomography (CT) have increased the sensitivity for detection of portomesenteric vein gas. At CT, portal vein gas appears as tubular areas of decreased attenuation in the liver, predominantly in the left lobe. Gas in the great mesenteric veins can easily be demonstrated with contrast material-enhanced CT, whereas gas in the small mesenteric veins appears as tubular or branched areas of decreased attenuation in the mesenteric border of the bowel. Findings of portomesenteric vein gas at CT should be carefully evaluated in the context of clinical findings. In the majority of cases, the prognosis is favorable and surgery is not required. However, when CT demonstrates portomesenteric vein gas and clinical findings suggest the presence of mesenteric ischemia, surgery is mandatory.
门静脉肠系膜静脉气体是一种罕见病症，其发病机制尚未完全明确。门静脉肠系膜静脉气体最常见的原因是肠系膜缺血，但也可能有多种其他病因。促使这种病理实体形成的主要因素是肠壁改变、肠扩张和脓毒症。在大约15%的病例中，门静脉肠系膜静脉气体是特发性的。诸如计算机断层扫描（CT）等先进成像技术提高了门静脉肠系膜静脉气体的检测灵敏度。在CT上，门静脉气体表现为肝脏内衰减减低的管状区域，主要位于左叶。通过对比剂增强CT很容易显示肠系膜大静脉内的气体，而肠系膜小静脉内的气体在肠管肠系膜缘表现为衰减减低的管状或分支状区域。CT上门静脉肠系膜静脉气体的表现应结合临床发现进行仔细评估。在大多数情况下，预后良好，无需手术。然而，当CT显示门静脉肠系膜静脉气体且临床发现提示存在肠系膜缺血时，则必须进行手术。
