Sonographically Detected Hepatic Portal Venous Gas – Prevalence, Causes, and Clinical Implications

Abstract

Purpose Hepatic portal venous gas (HPVG) is a rare clinical finding, often caused by a severe underlying disease. In the literature as well as in clinical practice, HPVG is considered “signum malum” with a poor prognosis and bowel ischemia as the most common cause. Most studies are based on the results of computed tomography (CT) examinations. The aim of this retrospective study is to report on the prevalence, causes, and clinical course of HPVG in a monocentric cohort of abdominal ultrasound (US) investigations.

Materials and Methods The US database of an academic teaching hospital was searched with specific keywords (timespan 01/2000 to 12/2020). Reports, pictures, and clinical data of all cases with HPVG were re-evaluated.

Results Out of 134 804 US examinations, 8 HPVG cases were identified. There was a wide variety of underlying diseases, with mesenteric ischemia being seen in only 2 cases. 5 patients were discharged in stable condition, with 4 of them having undergone surgical treatment. 2 patients who had rejected further measures died, and one was lost to follow-up.

Discussion HPVG is a rare phenomenon in clinical US. However, ultrasonographic prevalence is comparable to the prevalence in CT studies. Underlying diseases are mostly severe, and in nearly all cases an underlying cause can be found by thorough investigation. In some cases, US may even be superior to CT scans for the detection of HPVG. Despite its rarity, every sonographer should know the typical sonographic presentation of HPVG, and appropriate images should be included in US teaching modules.

Zusammenfassung

Ziel Gas im hepatoportalen System (HPVG) ist ein seltener klinischer Befund, meist durch eine schwerwiegende Erkrankung hervorgerufen. Als häufigste Ursache gilt die mesenteriale Ischämie, weshalb das Phänomen als “Signum malum” mit schlechter Prognose beschrieben wird. Die meisten Studien basieren auf CT-gestützten Untersuchungen. In dieser retrospektiven Studie werden in einer monozentrischen Kohorte Prävalenz, Ursachen und klinische Implikationen von sonografisch diagnostiziertem HPVG untersucht.

Material und Methoden Die Sonografie-Datenbank eines Lehrkrankenhauses wurde mit definierten Stichworten auf die Diagnose von HPVG durchsucht (Zeitraum 01/2000 bis 12/2020). Befunde, Bilder und klinische Daten aller identifizierten Fälle wurden reevaluiert.

Ergebnisse Bei insgesamt 134 804 Ultraschalluntersuchungen konnten 8 Fälle von HPVG detektiert werden. Die zugrunde liegenden Erkrankungen differierten, eine mesenteriale Ischämie zeigte sich in nur 2 Fällen. 5 Patienten wurden in stabilem Allgemeinzustand nach Hause entlassen, 4 von ihnen waren zuvor operiert worden. 2 Patienten verstarben nach Ablehnung aller Interventionen, einer konnte nicht nachverfolgt werden.

Schlussfolgerungen HPVG ist ein selten beschriebener Befund in der klinischen Sonografie. Die Prävalenz ist vergleichbar zu CT-basierten Studien. Zugrunde liegende Erkrankungen sind häufig schwerwiegend; fast immer kann bei gründlicher Untersuchung eine Ursache gefunden werden. In einigen Fällen kann die Sonografie dem CT in der Detektion überlegen sein. Das typische Bild von HPVG sollte trotz seiner Seltenheit allen Ultraschalldiagnostikern bekannt sein und in die Sonografie-Ausbildung integriert werden.

Key words

ultrasound - retrospective study - hepatic portal venous gas

Publikationsverlauf

Eingereicht: 06. Juli 2021

Angenommen: 08. März 2022

Artikel online veröffentlicht:
28. April 2022

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