Farhan Ahmed, Talha M, Idris M.
Case of portal venous gas secondary to pneumococcal pneumonia detected on gray scale sonography but not by computed tomography.
Pak J Radiol Jan ;18(1):12-3.

An 18-year-old man presented to our hospital with complaints of fever with rigors, pain in right hypochondrium and vomiting for 1 day. On examination patient was febrile with fever of 39oC, mild hepatomegaly with tenderness in right hypochondrium. Laboratory workup revealed Hb of 11mg/dl, W.B.C. of 21,000 and deranged coagulation with I.N.R. of 1.69. His chest X-ray in ER showed consolidation in right lower lobe. As there was tenderness in right hypochondrium with hepatomegaly ultrasound abdomen was requested which revealed air in portal venous channels and mild hepatomegaly. No focal lesion or cause for portal venous gas could be ascertained. CT was advised but it was deferred till next day as patient went into septic shock. Enhanced CT abdomen was performed after 14-hours of ultrasound which did not show the portal venous air however mild hepatomegaly and right lower lobe consolidation were shown well.

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