Portal venous gas on hepatic ultrasound: A concerning finding in the critically ill patient that should encourage critical reflection on the differential.



The images (CT | US) demonstrate peripheral tracking of air in the hepatic portal venous system. The U/S image demonstrates hyperechoic bubbles traversing the portal vein. In adults, this can occur as a consequence of bowel wall disruption (i.e. mesenteric ischemia, perforated peptic ulcer), bowel wall distension (i.e. ileus), intra-abdominal sepsis and a variety of other causes. This finding is an urgent indication for further investigations and specialist referral, but notably can occur with benign conditions. 



- Alberta Sono @UAlberta_Sono



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