RadFYI: Portal venous gas is one of the most critical catastrophes that can develop as a result of pneumatosis, so do call on the classics here: branching lucencies within the liver.
Not Nothing: Reading neonatal abdominal radiographs straddles that line between the overly sensitive “call me, maybe” and the specific and definitive. As Dr. Andrew T. Trout reminded us during the ARRS Online Course Radiology Case Review – Pediatric Imaging, calling pneumatosis is not a benign diagnostic event.
- Usually, a positive read prompts clinicians to rest the baby’s gut, make them nothing by mouth, and initiate total parenteral nutrition.
- Since such interventions carry their own risks, prioritize specificity over hypersensitivity.
Clear-cut cases present with obvious intramural collections of linear or curvilinear gas across multiple loops…or the presence of portal venous gas!
- Trout’s Tip: Do not call pneumatosis unless you see clear, indisputable intramural lucencies (either linear or curvilinear) in the context of other concerning clinical findings.
Grey Zone: When faced with subtle, bubbly lucencies in the hemi-abdomen, obtaining a delayed, follow-up radiograph is a highly reasonable and helpful strategy. Over time, true pneumatosis will progress to show more convincing, clearly intramural curvilinear lucencies on a delayed radiograph.
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