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Pneumatosis intestinalis is due to the production of small bubbles of hydrogen by bacteria within the intestinal wall (Albanese and Rowe 1998). Intramural air bubbles may also represent extravasated air from within the intestinal lumen. These changes might not be detectable on digitalized images due to the suboptimal resolution, and a printed X-ray fi lm is often necessary (Morrison and Jacobson 1994). Serial radiographs help assess disease progression. Abdominal free air is ominous and usually requires emergency surgical intervention (Fig.

The mass is most often seen in the upper right quadrant projecting over the right kidney (Ratcliffe et al. 1992) (Fig. 44). The “meniscus sign” consists of a crescent of gas within the colonic lumen that outlines the apex of the intussusception (the intussusceptum) (Fig. 45). Conversely, identification of a cecum fi lled with air or feces in the normal location is the finding that allows exclusion of intussusception with the most confidence (Sargent et al. 1994). However, plain abdominal radiography is normal in 40%–50% (Sargent et al.

Although it affects mostly premature infants, 10% of affected infants are born at term. 4% amongst infants of less than 1500 g. Males and females are equally affected. Most infants develop NEC within the first 2 weeks of life (Krasna et al. 1996). Its precise cause remains unclear, but it is thought that factors such as ischemia, decreased mucus production, and diminished immune response of the premature infant may lead to invasion of the intestinal mucosa by intestinal flora resulting in air entering the submucosa and mucosa.

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