In Response to the Article “Usefulness of Ultrasound Examinations in the Diagnostics of Necrotizing Enterocolitis”. Pol J Radiol, 2015; 80: 1–9

Here we present a case of a neonate with NEC, with an emphasis on portal venous gas. A 21-day-old neonate born at full term with normal vaginal delivery presented with poor feeding and vomiting. An abdominal US was ordered with a clinical suspicion of hypertrophic pyloric stenosis. It revealed foci of free air within the peritoneal cavity and air within the walls of the small bowel loops (Figure 1). Hepatopetal movement of air bubbles was also seen within the main portal vein and its major branches (Video 1). Liver parenchyma showed multiple echogenic foci suggesting trapped air within small portal branches. That prompted confirmation of the findings with an abdominal radiograph which showed typical features of NEC including pneumatosis intestinalis and pneumoperitoneum (Figure 2). The radiograph however failed to demonstrate hepatic portal venous gas (HPVG).