What imaging finding is suggestive of necrotizing enterocolitis?

Air in the bowel wall, which is known as pneumatosis intestinalis, is a key imaging finding suggestive of necrotizing enterocolitis (NEC). This condition is most commonly seen in premature infants and is characterized by damage to the intestinal lining, leading to the entrance of gas-forming bacteria into the bowel wall. The presence of air in the wall indicates that the bowel is undergoing necrosis, which is a critical sign that points to the disease process.

Other imaging findings, such as fluid collections or the absence of bowel gas, can indicate different abdominal conditions but are less specific to NEC. An enlarged liver and spleen may be seen in various infectious or metabolic conditions but are not definitive for necrotizing enterocolitis. Therefore, recognizing air in the bowel wall on imaging is crucial for diagnosing this serious gastrointestinal emergency in neonates, assisting healthcare providers in taking timely and appropriate action.