GI imaging: pneumatosis with portal venous gas: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · GI imaging: pneumatosis with portal venous gas

Sample item

An elderly man with atherosclerosis has shock, severe abdominal pain and a raised lactate. CT shows gas within the bowel wall and branching gas in the portal venous system. What is the most appropriate management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Urgent surgical review for transmural bowel infarction

Pneumatosis with portal venous gas in an acutely ill patient suggests transmural ischaemia and carries high mortality. It calls for resuscitation and emergency surgical assessment. The same signs in a well patient can have benign causes, so the clinical context decides.

Option by option

  • A. Observation and repeat CT in a week

    Waiting a week is dangerous in suspected infarction.

  • B. Oral antibiotics and discharge

    Oral antibiotics are not adequate.

  • C. Colonoscopic decompression

    Colonoscopy does not treat transmural infarction and risks perforation.

  • D. Urgent surgical review for transmural bowel infarction (correct)

    Correct. This pattern with sepsis and lactic acidosis needs emergency surgery.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Urgent surgical review for transmural bowel infarction. Pneumatosis with portal venous gas in an acutely ill patient suggests transmural ischaemia and carries high mortality.

Why is "Observation and repeat CT in a week" not the answer?

Waiting a week is dangerous in suspected infarction.

Why is "Oral antibiotics and discharge" not the answer?

Oral antibiotics are not adequate.

Why is "Colonoscopic decompression" not the answer?

Colonoscopy does not treat transmural infarction and risks perforation.

What concept does this question test?

It tests GI imaging: pneumatosis with portal venous gas in Radiology. It calls for resuscitation and emergency surgical assessment. The same signs in a well patient can have benign causes, so the clinical context decides.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study GI imaging: pneumatosis with portal venous gas?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.