[Imaging and clinical significance of hepatic portal venous gas seen in adult patients].

In 10 adult patients with hepatic portal venous gas (HPVG), the clinical significance of HPVG and the efficacy of X-ray computed tomography (CT) were evaluated. HPVG was associated with ischemic bowel disease (n = 3), trauma (n = 4), liver abscess (n = 1), sepsis (n = 1), and unknown etiology (n = 1). The diagnostic ability of CT for the detection of HPVG was far superior to that of plain abdominal radiograph. Of 9 patients who underwent CT, HPVG located in the left hepatic lobe in all patients, and also in right hepatic lobe in 7 patients. Gas could be recognized in the left lobe and the anterior segment of the right lobe more clearly than in the posterior segment of the right lobe because of its larger amount of intravenous collection. The mortality rate of our cases was 100%. Gas was demonstrated simultaneously in the portal vein radicles and hepatic veins on CT in 4 patients with no clinical evidence of sepsis, which suggested the possibility of intraparenchymal shift of gas from the portal vein into the hepatic vein. In a single case with sepsis, gas was noted in various vessels, including arteries, in addition to the portal venous system. The authors conclude that HPVG is still a grave sign in Japan and prompt appropriate treatment is required. CT may be of great value in the early detection of HPVG and may indicate its etiology.