Ultrasound Diagnosis of Hepatic Portal Venous Gas (HPVG) Misidentified as Emphysematous Cystitis in Elderly Diabetic Dialysis Patient

Hepatic portal venous gas (HPVG) refers to the presence of air bubbles within the portal vein and its branches. Historically, HPVG was viewed as a critical condition, often linked to bowel ischemia. However, advancements in diagnostic imaging have revealed that the etiologies of HPVG are varied and can extend beyond bowel necrosis. In this report, we present a rare case involving an elderly patient with diabetes mellitus undergoing dialysis, in whom HPVG was initially identified through ultrasound and confirmed by a CT scan. The patient exhibited abdominal pain, dysuria, oliguria, and other urinary symptoms that had begun three weeks prior to diagnosis. A comprehensive assessment that included various diagnostic modalities, alongside a thorough correlation with the patient’s medical history and clinical findings, ultimately pointed to emphysematous cystitis as the underlying cause of the HPVG. This case underscores the importance of recognizing HPVG in initial diagnostic evaluations, as it necessitates a thorough investigation to uncover the root cause. Notably, conditions like emphysematous cystitis, while rare, can manifest as HPVG, highlighting the need for vigilance in diagnosing and managing patients with unexplained HPVG. Our findings emphasize that HPVG should not only be seen as a straightforward indicator of severe bowel pathology but rather as a potential signal for a range of underlying conditions that warrant immediate and detailed exploration.