Hepatic Portal Venous Gas and “The Aquarium Sign” Due to Intussusception in Kawasaki Disease

The presence of hepatic portal venous gas (HPVG) may be secondary to bowel necrosis, mechanical distension, or intraabdominal sepsis. We describe an unusual and hitherto unreported presence of HPVG manifesting as gas embolization and the unique “aquarium sign” in a patient of Kawasaki's disease. Continuous passage of bubble-like echoes flowing from the hepatic portal venous system into the inferior vena cava and right-sided chambers of heart was noted on echocardiography. The patient was treated with intravenous immune-globulins and made an uneventful recovery.