What radiological finding is pathognomonic for necrotizing enterocolitis?

Pneumatosis intestinalis is considered a pathognomonic finding for necrotizing enterocolitis (NEC) in neonates. This condition is characterized by the presence of gas within the wall of the intestine, which can be seen on abdominal radiographs. The gas can originate from a breakdown of the intestinal mucosa due to inflammation and necrosis, leading to the formation of gas pockets in the bowel wall.

In the context of NEC, pneumatosis intestinalis indicates that there is significant bowel injury and often correlates with advanced stages of the disease. Early recognition of this finding is crucial in managing NEC, as it prompts clinicians to initiate interventions that may include discontinuation of feeds, initiation of broad-spectrum antibiotics, and possibly surgery for those with perforation or severe disease.

Other findings such as air-fluid levels, free air under the diaphragm, and small bowel obstruction can be seen in various gastrointestinal conditions but are not specific to necrotizing enterocolitis. Air-fluid levels are indicative of obstruction rather than necrosis. Free air under the diaphragm suggests perforation, which is a complication of several gastrointestinal disorders but not specific to NEC. Similarly, small bowel obstruction may result from a variety of causes, including congenital factors, adhes