Fig. 18

Intestinal vasculitis and benign intestinal pneumatosis in a 52-year-old male with a history of known Scleroderma presenting with abdominal pain. Physical examination revealed generalized abdominal tenderness without rebound or guarding. Upright CXR (A) was done in the ER. Pneumoperitoneum (thick black arrows) was noted at CXR in the absence of signs or symptoms of peritonitis. Due to this discrepancy, abdominal CT scan (B, C) was performed and confirmed pneumoperitoneum (thin black arrow) along with extensive intestinal pneumatosis in the transverse colon (black arrowheads) and jejunum (thick white arrows). The patient underwent conservative treatment. He was discharged one week later with improved signs/symptoms. After three weeks, MRE was obtained and displayed no pneumoperitoneum. Axial T2-W image (D) demonstrates segmental jejunal mural thickening (white dotted oval) with hypointense appearance. Coronal T2-W image (E) shows bowel dilation and the classic hidebound sign (black dotted oval) in the ileum related to known scleroderma. The T2 hypointense segment of thick jejunum is also seen (curved arrows), suggestive of chronic mural thickening perhaps due to fibrosis