Advancement in the diagnosis and treatment of hepatic portal venous gas

Hepatic portal venous gas (HPVG) is a rare yet clinically significant radiological manifestation characterized by diverse etiologies, unclear pathophysiology, and nonspecific clinical presentations. Its appearance frequently heralds a severe underlying condition, with a reported mortality rate as high as 75%, earning it the moniker "harbinger of death". In recent years, with advancements in diagnosis and treatment of HPVG, its mortality rate has been reduced to below 40%. Nevertheless, the infrequency of HPVG, coupled with its complex etiologies and rapid progression, often leaves clinicians failing to provide timely intervention due to a lack of awareness, resulting in the death of patient. Currently, there is no consensus on the standardized diagnosis and treatment strategies for HPVG. The purpose of this review is to synthesize the existing literature on HPVG and to discuss the advancements in understanding its clinical manifestation, etiologies, pathogenesis, diagnostic methods, and treatment strategies, as well as to emphasize the necessity for further research to enhance our comprehension of its pathophysiology and to refine diagnostic and therapeutic approaches.