Case report

We present a case of a 48-year-old male with no specific prior medical history. An optical colonoscopy (OC) was performed due to rectal bleeding. A submucosal round mass was detected on the OC that was 80 cm from the anal verge, which had a smooth surface and no ulcers (Fig. 1A). A computed tomography (CT) was performed which ruled out the presence of submucosal tumors or extrinsic compressions. Due to the endoscopic high risk of the underlying pathology, a virtual colonoscopy (VC) was performed. This confirmed the presence of an intramural, submucosal cystic gas space, with a thin wall that was located at the splenic angle of the colon. This was consistent with the OC findings (Fig. 1B-D).

Fig. 1 Focal Pneumatosis cystoides intestinalis. A. A submucosal mass with a smooth surface on colonoscopy. B. Endoluminal 3D reconstruction of a virtual colonoscopy showing a lesion with a polypoid morphology. C and D. Multiplanar 2D reconstructions with lung window demonstrating gas in the lesion. 

Discussion

The combination of OC and CV is effective for the differentiation of neoplastic from non-neoplastic processes, especially for the differential diagnosis of submucosal surface lesions and polyps. An OC has a limited value for submucosal masses as it only allows the study of the intestinal surface. CT and VC provide additional information about the origin, composition and extension of the lesions.

Multiplanar reconstructions with lung window on CT or VC provide additional information for the diagnosis of PCI, demonstrating gas in the lesion that was visualized by OC ⁴. The PCI usually appears as several gas cysts and less frequently as a focal lesion, such as in our case. Therefore, focal PCI should be considered as a benign cause of submucosal lesions on OC.