Residual Ultrasound-Enhancing Agents Mimicking Portal Venous Gas

Area of Science:

• Medical Imaging
• Gastroenterology
• Cardiology

Background:

• Echogenic foci in the portal vein or liver parenchyma are concerning for portal venous gas, often linked to bowel ischemia.
• Ultrasound-enhancing agents (UEAs) are common in abdominal and cardiac imaging.
• UEA appearance can mimic gas on ultrasound.

Purpose of the Study:

• To investigate the phenomenon of suspected portal venous gas being caused by residual ultrasound-enhancing agents.
• To emphasize the need to include UEA residuals in the differential diagnosis of echogenic foci.

Main Methods:

• Observational study of cases with suspected portal venous gas.
• Review of patient history for recent ultrasound-enhancing agent administration, particularly from contrast-enhanced echocardiography.

Main Results:

• Identified cases initially suspected of portal venous gas due to bowel ischemia were found to be caused by residual or persistent UEA.
• Demonstrated that UEA residuals can mimic the sonographic appearance of portal venous gas.

Conclusions:

• Residual ultrasound-enhancing agents from recent echocardiography can present as echogenic foci, mimicking portal venous gas.
• Clinicians should consider recent UEA administration when interpreting abdominal ultrasounds showing echogenic foci in the portal system or liver.