Figure 7a. Nonocclusive mesenteric ischemia in a 51-year-old woman with a history of left-sided heart failure. (a) Abdominal radiograph shows signs of pneumatosis coli (arrowheads). (b-d) Coronal VR image (b), sagittal MPR image (c), and curved MPR image (d) show air in the wall of the small bowel and ascending colon (arrowheads). (e, f) Axial source images show air collections in the intrahepatic vessels (arrows in e) and in the portal confluence (arrow in f) and an intraaortic balloon pump device in the aortic lumen (arrowhead in f). The device is shown in a to be in the correct position, and no occlusion is visible in the mesenteric arteries (arrow in d). The absence of occlusion was confirmed at pathologic analysis. The ischemia from low cardiac output probably was exacerbated by a reduction in peak systolic pressure caused by the intraaortic balloon pump.