Ultrasound capabilities in detecting gas in the portal venous system

Objective. To describe the ultrasound features of gas in the portal venous system and intramural gas in hollow organs in various pathologies, including both bowel wall necrosis and various transient non-necrotic conditions, using clinical case examples. Materials and methods. Between June 1 and November 9, 2024, at the S.S. Yudin City Clinical Hospital (Moscow Department of Health), ultrasound signs of gas in the portal venous system were detected in 16 patients. All these patients exhibited a severe overall condition, required treatment in the intensive care unit, and had unstable hemodynamics necessitating vasopressor therapy. The article presents the most illustrative clinical cases of portal venous gas from this cohort of 16 patients. Results. Case analysis demonstrated that the presence of gas in the portal venous system is not always indicative of bowel wall necrosis and may result from transient conditions. Conclusions. Ultrasound allows for the detection of gas within the portal venous system and within the walls of hollow organs. The presence of portal venous gas on ultrasound should not be interpreted as a sign of a single, specific disease, as it may reflect a range of pathological or transient conditions. Decisions regarding further diagnostic and therapeutic strategies upon detection of intramural or portal venous gas should be based on clinical and laboratory data.