FULL PATIENT HISTORY:54-year-old male with small cell lung cancer status post right pneumonectomy, radiation and chemotherapy. He subsequently developed a right parietal metastasis and is status post surgical resection and radiation therapy. He presented with several months of weakness, 40 pound weight loss and was admitted for abdominal pain.The PET/CT was requested to evaluate suspected recurrence of the cancer.

DISCUSSION:Colonic pneumatosis and pneumoperitoneum were incidentally detected on the PET/CT. At laparotomy the colon was seen to be dilated and appeared chronically ischemic all the way down to the mid-descending colon. There was clearly air that had escaped into the omentum. However, no discrete perforation or intra-abdominal contamination was seen. Subtotal colectomy with RLQ end-ileostomy and LLQ mucous fistula were performed.Mucosal ulceration with transmural inflammation and focal abscess formation were seen on surgical pathology.