Figure 7c. Emphysematous gastritis in a 33-year-old man with a history of ethanol abuse. (a) Abdominal radiograph obtained with the patient upright shows mottled and irregular collections of gas within the stomach wall (arrows). An endogastric tube and abdominal surgical clips are also seen. (b) Contrast-enhanced CT scan through the upper abdomen clearly demonstrates a massive collection of intramural gas (white arrows). Enteric contrast material defines the gastric lumen (*). Periportal edema is also seen (black arrows). (c) Photograph of the gross specimen reveals diffuse hemorrhagic necrosis (arrows) and thickened mucosal folds. A large number of gram-positive cocci were seen at histologic analysis.