Differentiating Benign and Clinically Worrisome Pneumatosis Intestinalis in Children

Pneumatosis intestinalis can have a benign or complicated course in children beyond the neonatal period. Benign cases are self-limited and can be managed conservatively. Benign causes of pneumatosis intestinalis include

• Asthma
• Bronchitis
• Scleroderma
• Systemic lupus erythematosus
• AIDS
• Postsurgical anastomosis
• Endoscopy
• Corticosteroids
• Organ transplantation

CT can be used to suggest whether pneumatosis intestinalis reflects a benign or clinically worrisome cause.

CT Finding	Benign	Worrisome
Extensive involvement	+
Bowel wall thickening		+
Peri-bowel stranding		+
Free Fluid		+

The following CT findings are not helpful in differentiating benign and clinically worrisome cases of pneumatosis intestinalis in children:

• Morphology of gas (cystic vs linear)
• Distribution (small bowel, large bowel, or both)
• Free peritoneal gas
• Bowel dilatation
• Small bowel obstruction
• Portal venous gas

References

Olson DE, Kim YW, Ying J, Donnelly LF. CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology. 2009 Nov;253(2):513-9.