Pneumatosis cystoides intestinalis: when the location of the air may be a pitfall

Abstract

Pneumatosis cystoides intestinalis (PCI) is a rare and generally benign condition characterized by air within the walls of the small intestines or colon. Moreover, it may be a cause of free air in peritoneum. To correctly manage this entity when found at CT, it is of crucial importance for the radiologist to recognize and distinguish it from life-threatening causes of pneumatosis intestinalis or pneumoperitoneum. This differentiation may be challenging and the absence of additional findings (bowel wall thickening, altered contrast mucosal enhancement, fat stranding, dilated bowel, ascites, and the presence of portal venous gas) may be very helpful in suggesting the diagnosis. In this short communication we present a case of PCI in an asymptomatic 60-year old woman with a history of uterine carcinoma. The patient underwent a colonoscopy after a positive result of fecal occult blood test; the colonoscopy showed the presence of multiple grape-like nodules in the splenic flexure of the colon and biopsies were performed to exclude malignity of the findings. Then, a CT was conducted and it showed the presence of multiple, thin-walled, air-filled submucosal cysts in the splenic flexure of the colon. The endoscopic and CT findings, together with the absence of abdominal symptoms and altered laboratory test, allowed to establish the diagnosis of PCI. The patient was managed conservatively. Moreover, some free air bubbles were found in the pneumoperitoneum at one-year and two-year follow-up CTs, without abdominal symptoms.