A case of intramediastinal arterial gas associated with portal venous gas that resolved with conservative treatment

Abstract

A 90s-year-old man was brought to the emergency department with a chief complaint of impaired consciousness and hypotension. Blood test showed hyponatremia, and contrast-enhanced CT of the abdomen revealed marked portal venous gas, poor contrast image of the wall and pneumatosis of the left colon, and ascites. But blood test showed no elevated inflammatory response and there was no peritoneal irritation symptom. Plane CT of the chest showed gas in the brachiocephalic trunk and the left subclavian artery. He was diagnosed with portal venous gas caused by ischemic colitis and intramediastinal arterial gas. The patient was hospitalized for conservative treatment in accordance with the family's wishes. His consciousness was improved after recovery of hyponatremia. Contrast-enhanced CT of the abdomen on the 18th day showed decreasing of portal venous gas and ascites. During the hospitalization, he did not show any symptoms and could be discharged.