Question:

Which of the following is true?
1. Portal venous gas can extend up to 1cm below the liver capsule
2. Pneumoperitoneum can be confused with mesenteric venous gas on imaging
3. Bile flow within the liver is described as "centrifugal"
4. In doppler examination, gas has a slower velocity than flowing blood
5. Mesenteric gas is most commonly seen at the anti-mesenteric border of the bowel





Answer:

The correct answer for the question "Which of the following is true?" is:

1. Portal venous gas can extend up to 1cm below the liver capsule



Explanation
a. [The computed tomography findings of portal gas is described as branching hypodensities extending to within 2 cm of the liver capsule]
b. [Mesenteric venous gas should not be confused with pneumoperitoneum. Pneumoperitoneum does not have a tubular or branched appearance and can be found in the interface between the anti-mesenteric border of the bowel and the parietal peritoneum]
c. [Gas within the intrahepatic biliary channels (pneumobilia) should be differentiated from the gas within the portal tracts. The former being located more at the central portion of the liver owing to the centripetal flow of bile]
d. [Gas can be distinguished by its echo characteristics and, in real time, by a velocity greater than that expected for blood within the vessel]
e. [Gas in the small mesenteric veins appears as tubular or branched areas of decreased attenuation in the mesenteric border of the bowel]



From the manuscript:
Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings
Radiology Case. 2014 Jul; 8(7):20-27


This article belongs to the GI section.




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From the manuscript

Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

Free full text article: Case report: Portal and systemic venous gas in a patient with perforated duodenal ulcer: CT findings

Abstract
Gas within the portal circulation has been known to be associated with a number of conditions most commonly mesenteric ischemia and necrosis. Systemic venous gas is described with few conditions and is mostly iatrogenic in nature. We describe a case of combined portal and systemic venous gas detected by computed tomography in a patient with perforated duodenal ulcer.






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