Journal List > J Korean Soc Radiol > v.80(2) > 1138889

Ko, Shim, Kim, and Chang: Pneumatosis Intestinalis Associated with Pulmonary Disorders



To determine the clinical features, imaging findings and possible causes of pneumatosis intestinalis (PI) in thoracic disorder patients.

Materials and Methods

From 2005 to 2017, Among 62 PI patients, four of PI related with thoracic disease (6%) were identified. Medical records were reviewed to determine the clinical presentation, laboratory findings and treatment at the time of presentation of PI. Two experienced chest radiologists reviewed all imaging studies and recorded specific findings for each patient.


The causative thoracic diseases for each four patient were severe asthma, emphysema and airway obstruction. The imaging appearance of PI, including the involved bowel segment and pattern of the air, were divided into two mesenteric vascular territories; three of our cases showed linear pattern of PI located in the ascending & proximal transverse colon and the fourth case (lung cancer) had bubbly and cystic PI in the distal transverse and descending colon. All of the remaining 3 patients, except one patient who had not been followed up, improved within 1 month by conservative treatment.


Thoracic disorder with obstructive lung disease may result in the development of benign PI. Such PI in thoracic disease patients has a similar linear and cystic appearance with ischemic bowel disease, but can nevertheless be managed by conservative treatment.


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Fig. 1.
A 43-year-old woman with severe asthma. A. Chest X-ray posterior-anterior views shows pneumomediastinum (arrows) with PI (arrowheads) on initial chest radiography. B. These lesions are completely resolved after 1 month with conservative treatment. C, D. Transverse and coronal abdomen CT scans (2.0-mm slice thickness) obtained with lung and wide window show linear patterns of PI involving from the cecum to proximal transverse colon.
Fig. 2.
A 79-year-old man with lung cancer. A. Chest X-ray posterior-anterior views shows decreased volume of left lung with mass and a nodule in right lower lung zone. B. Transverse contrast-enhanced CT scan obtained with mediastinal window shows a large necrotic mass causing nearly complete stenosis of left main bronchus (arrow). C. Coronal chest CT scan obtained with lung setting shows cystic and bubbly appearance of pneumatosis intestinalis involving distal trans-
Fig. 3.
A 71-year-old man with choking by food material and aspiration pneumonia. with residual food and mucoid impaction in the left main bronchus. B, C. Transverse and coronal abdomen CT scan with bone window shows a linear pattern of pneumatosis intestinalis in the ascending colon. A. Transverse chest CT scan obtained with lung window taken after removal of aspirated food material shows atelectasis of left lower lobe
Table 1.
Clinical Findings in Four Patients with Pneumatosis
Patients Presenting Symptoms Underlying Disease Initial Department Initial Diagnostic Study PaO2 Final Diagnosis Medication Outcome of Pneumatosis Intestinalis
No. Sex/Age Initial Chief Complaint Duration Abdomen Symptom
1 F/43 Dyspnea 4 days Indigestion Asthma Emergency room Chest PA Chest CT 81.7 Asthma exacerbation Methylon Resolved in 1 month
2 M/79 Dyspnea 7 days Poor oral intake Pulmonary emphysema Respiratory medicine Chest PA Chest CT Lung cancer (left main bronchus obstruction) Follow up loss
3 F/53 Dyspnea 3 days AML Hematologic medicine Abdomen CT 51.2 GVHD and pneumonia Methylon Antibiotics Resolved in 17 days
4 M/71 Dyspnea & mental change Abrupt Abdomen distension Emergency room Chest PA Brain CT Chest CT 33.1 Airway obstruction by food impaction and aspiration pneumonia Endoscopic removal of food material Resolved in 7 days

AML = acute myeloid leukemia, GVHD = graft-versus-host disease, PA = posteroanterior, PaO2 = partial pressure of oxygen

Table 2.
Radiologic Findings in Four Patients with PI
No. Chest Abdomen CT
Chest X-Ray CT Pneumoperitoneum PI Distribution Pattern Extra-Luminal Gas Distribution
Thorax Pneumoperitoneum PI
1 Pneumomediastinum PI Pneumomediastinum Asthma Y Y Y Y Cecum to proximal transverse colon Linear Retroperitoneum, liver bare area
2 Lung mass PI Lung cancer in left lung Pulmonary emphysema N Y N Y Distal transverse colon to descending colon Bubbly and cystic N
3 –PI Stable TB Pulmonary emphysema Y Y Y Y Cecum to hepatic flexure of colon Linear Paracolic gutter
4 Atelectasis in BLLZ PI Atelectasis in LLL Partial atelectasis in RLL L N Y Y Y Cecum to hepatic flexure of colon Linear Small bowel mesentery around right psoas muscle, anterior aspect of aorta and IVC

Scanned abdominal images on chest CT.

PI = pneumatosis intestinalis, BLLZ = both lower lung zones, IVC = inferior vena cava, LLL = left lower lobe, RLL = right lower lobe, TB = tuberculosis

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