Clinical phenotypes and imaging evolution of hepatic portal venous gas under conservative management: a single-center case series using albumin and procalcitonin as prognostic stratification anchors.

Background: Hepatic portal venous gas (HPVG) is a rare but clinically significant radiologic finding associated with diverse intra-abdominal and systemic diseases. Once considered a fatal sign, its prognosis now varies widely due to advances in imaging and supportive care. This study aimed to characterize the clinical features, etiologies, imaging patterns, and prognostic factors of HPVG managed conservatively. Methods: A retrospective analysis was conducted on 16 patients diagnosed with HPVG by CT between January 2017 and June 2025 at Shiyan People's Hospital, Hubei University of Medicine. Demographics, comorbidities, laboratory data, imaging findings, and outcomes were reviewed. Group comparisons employed the Results: Among the 16 patients, 11 were male (68.8%), with a mean age of 61.1 ± 15.8 years. The major etiologies were intra-abdominal infection (31.3%), gastrointestinal bleeding (25%), intestinal obstruction (18.8%), and perforation (12.5%). All received conservative management, with an in-hospital mortality rate of 62.5%. Non-survivors had significantly lower serum albumin and higher procalcitonin (PCT) levels, while brain natriuretic peptide (BNP) showed weak association with mortality. Other demographic and biochemical variables showed no significant differences. Conclusion: In conservatively treated HPVG, hypoalbuminemia and elevated PCT were strongly associated with mortality. Imaging follow-up demonstrated complete gas resolution in several patients after control of the underlying disease, indicating HPVG represents a radiologic manifestation rather than a disease entity. Combined evaluation of imaging dynamics and biomarkers may aid early risk stratification and guide individualized management. Further multicenter prospective studies are warranted to validate these findings.