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Hepatic portal venous gas in children: why ultrasound matters more than ever – a literature review
1
Szpital Praski p.w. Przemienienia Pańskiego, Warszawa, Polska / Praski Hospital of the Transfiguration of the Lord, Warsaw, Poland
2
Międzyleski Szpital Specjalistyczny w Warszawie, Polska / Międzylesie Specialist Hospital in Warsaw, Poland
3
I Oddział Chorób Wewnętrznych, Szpital Bielański im. ks. Jerzego Popiełuszki, Warszawa, Polska /
First Department of Internal Medicine, Bielański Hospital named after Father Jerzy Popiełuszko, Warsaw, Poland
4
Państwowy Instytut Medyczny MSWiA, Warszawa, Polska / National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland
5
Samodzielny Publiczny Specjalistyczny Szpital Zachodni im. św. Jana Pawła II, Grodzisk Mazowiecki, Poland / John Paul II Western Hospital in Grodzisk Mazowiecki, Poland
6
LUX MED Sp. z o.o., Warsaw, Poland
7
Centralny Szpital Kliniczny, Uniwersyteckie Centrum Kliniczne Warszawskiego Uniwersytetu Medycznego, Polska / Central Clinical Hospital, University Clinical Center, Medical University of Warsaw, Poland
8
Wydział Medyczny, Collegium Medicum, Uniwersytet Rzeszowski, Polska / Faculty of Medicine, Collegium Medicum, University of Rzeszow, Poland
Corresponding author
Ann. Acad. Med. Siles. 2025;79:269-275
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Hepatic portal venous gas (HPVG) is a rare, yet alarming finding in pediatric patients that is historically linked to a mortality rate reaching 75%. However, advancements in imaging techniques now reveal that in many cases it is transient and benign. In this study, we focus on the growing role of ultrasonography in diagnosing pediatric patients with HPVG, highlighting its value in clinical practice.
Material and Methods:
A literature review was conducted using PubMed and Google Scholar. The search terms were “hepatic portal venous gas,” “pediatrics,” “ultrasonography,” “diagnostic imaging,” “necrotizing enterocolitis,” and related variations thereof.
State of knowledge:
HPVG can be detected by multiple imaging methods. Interestingly, ultrasonography stands out from the others for its high sensitivity in HPVG detection, lack of ionizing radiation, and real-time results. In pediatric patients, an extended ultrasound exam not only detects HPVG, but also enables clinicians to stratify risk by analyzing gas distribution patterns and other sonographic markers linked to poorer outcomes. Furthermore, ultrasound aids in refining differential diagnoses by tracking the flow of gas through the intricate branches of the portal venous system. Crucially, when HPVG detection via ultrasound is combined with Gordon’s criteria, diagnostic accuracy for necrotizing enterocolitis improves significantly, reaching a specificity of 86% and a sensitivity of 90%. This highlights the growing indispensability of ultrasonography in pediatric care.
Conclusions:
Ultrasonography is a powerful, non-invasive tool that enhances HPVG diagnosis and clinical decision-making. Given its advantages, we propose it as an imaging method of choice for the diagnosis of children with HPVG.
Hepatic portal venous gas (HPVG) is a rare, yet alarming finding in pediatric patients that is historically linked to a mortality rate reaching 75%. However, advancements in imaging techniques now reveal that in many cases it is transient and benign. In this study, we focus on the growing role of ultrasonography in diagnosing pediatric patients with HPVG, highlighting its value in clinical practice.
Material and Methods:
A literature review was conducted using PubMed and Google Scholar. The search terms were “hepatic portal venous gas,” “pediatrics,” “ultrasonography,” “diagnostic imaging,” “necrotizing enterocolitis,” and related variations thereof.
State of knowledge:
HPVG can be detected by multiple imaging methods. Interestingly, ultrasonography stands out from the others for its high sensitivity in HPVG detection, lack of ionizing radiation, and real-time results. In pediatric patients, an extended ultrasound exam not only detects HPVG, but also enables clinicians to stratify risk by analyzing gas distribution patterns and other sonographic markers linked to poorer outcomes. Furthermore, ultrasound aids in refining differential diagnoses by tracking the flow of gas through the intricate branches of the portal venous system. Crucially, when HPVG detection via ultrasound is combined with Gordon’s criteria, diagnostic accuracy for necrotizing enterocolitis improves significantly, reaching a specificity of 86% and a sensitivity of 90%. This highlights the growing indispensability of ultrasonography in pediatric care.
Conclusions:
Ultrasonography is a powerful, non-invasive tool that enhances HPVG diagnosis and clinical decision-making. Given its advantages, we propose it as an imaging method of choice for the diagnosis of children with HPVG.
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