Pneumatosis: Appearances on CT Imaging

Background:Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments. Purpose: In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues. Methods: On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema. Results: Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum. Conclusion: Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology.