Pneumatosis cystoides intestinalis: lung window setting on CT.

Pneumatosis cystoides intestinalis is a rare and often presents nonspecific symptoms. In this case, CT imaging revealed air collection within the wall of the ileum, which was more clearly defined using the lung window setting. When we consider pneumatosis cystoides intestinalis, we should evaluate CT using the lung window setting.

Case

An 84‐year‐old man presented with a 7‐day history of nausea, appetite loss, and general fatigue. Computed tomography (CT) imaging of the abdomen revealed a small air collection within the wall of the ileum, which was more clearly defined as a smooth‐layered air collection using the lung window setting. This observation initially suggested bowel necrosis; however, the general appearance was not so serious, and there were no abnormalities in laboratory data. Furthermore, the smooth‐layered air collection within the wall of the ileum suggested pneumatosis cystoides intestinalis (PCI) rather than bowel necrosis. The patient had been treated with alpha‐glucosidase inhibitor acarbose for type 2 diabetes mellitus, which we suspected was the cause of his condition 1. He discontinued the medication, and he was treated with the oxygen therapy 2 (2 L/min) using a nasal cannula. A few days later, his symptoms improved, and the air collection disappeared from CT imaging. He discontinued the oxygen therapy, and oral intake started 3 days after admission, and the patient was discharged 3 days later. When we consider PCI, we should evaluate CT using the lung window setting (Figs. 1 and 2).

Figure 1

CT imaging of the abdomen revealed a small air collection within the wall of the ileum (red arrow); however, the finding was not clear.

Figure 2

The small air collection within the wall of the ileum was more clearly defined as a smooth‐layered air collection (red arrow) using the lung window setting.

Authorship

YK: prepared the entire manuscript. MO, YK, and SM: contributed to manuscript preparation.

Conflict of Interest

None declared.