Pneumatosis intestinalis: role of computed tomography in diagnosis and management

Four patients with pneumatosis intestinalis (PI) demonstrated by computed tomography are presented. Computed tomography delineated the location and extent of PI more accurately than plain abdominal radiographs and demonstrated any coexisting abdominal pathology. Lung window settings were important in the detection of intramural air and obviated the need for intraluminal contrast to outline the circumferential pattern of PI. In one patient PI would have been overlooked entirely using only conventional abdominal window settings. This technical observation could have potential clinical significance in the investigation of patients with suspected intestinal ischemia or gangrene where the appearance of intramural air is an ominous prognostic sign.