CT features can identify pneumatosis intestinalis (PI), commonly associated with necrotizing enterocolitis in newborns, and
differentiate between benign and clinically worrisome cases in older children. In a retrospective study, Olson and colleagues
identified 44 children—mean age of 8.45 years—with PI. The researchers found that soft-tissue thickening of the bowel wall,
free intraperitoneal fluid, periintestinal soft-tissue stranding, and extent of pneumatosis were useful in differentiating
benign from pathologic cases. Neither a cystic or a linear pattern of pneumatosis was useful for differentiation in children;
presence of free intraperitoneal air or portal venous gas does not imply a clinically worrisome cause of pneumatosis, the
researchers noted, and more extensive pneumatosis was more commonly associated with benign PI.