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Presented by Dr. Pedram Argani and prepared by Dr. Kevan Salimian
This is a 72 year old female with abdominal pain.
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1. Question
This is a 72 year old female with abdominal pain. Choose the correct diagnosis.
Correct
Answer: Pneumatosis cystoides intestinalis
Histologic Description: Throughout the thickness of the bowel wall, extending from the submucosa to the subserosa, are gas filled spaces lined by multinucleate giant cells. These are the diagnostic features of pneumatosis cystoides intestinalis. In some cases, pneumatosis cystoides intestinalis is of unclear etiology, but most cases are associated with either mucosal damage or dissection of the air emanating from ruptured pressurized lung cysts from the mediastinum into the mesentery and on into the bowel.
Differential Diagnosis: Colitis cystica profunda is associated with prolapse, and features large spaces as seen in the current case except those spaces are filled with directing mucin. Artefactual air spaces associated with trauma from colonoscopy (colonic pseudolipomatosis) are not associated with giant cell reaction. The granulomas of tuberculosis would be associated with central necrosis, not central air spaces.
Incorrect
Answer: Pneumatosis cystoides intestinalis
Histologic Description: Throughout the thickness of the bowel wall, extending from the submucosa to the subserosa, are gas filled spaces lined by multinucleate giant cells. These are the diagnostic features of pneumatosis cystoides intestinalis. In some cases, pneumatosis cystoides intestinalis is of unclear etiology, but most cases are associated with either mucosal damage or dissection of the air emanating from ruptured pressurized lung cysts from the mediastinum into the mesentery and on into the bowel.
Differential Diagnosis: Colitis cystica profunda is associated with prolapse, and features large spaces as seen in the current case except those spaces are filled with directing mucin. Artefactual air spaces associated with trauma from colonoscopy (colonic pseudolipomatosis) are not associated with giant cell reaction. The granulomas of tuberculosis would be associated with central necrosis, not central air spaces.
