Introduction:

The differentiation, in the radiological interpretation, between pneumobilia and portal gas has clinical and therapeutic implications of great importance. The present work is focused on describing the most relevant radiologic and clinical criteria of these two entities, with the objective of reducing confusion among them.

Case report:

A 40-year-old male patient, with gastrointestinal symptoms, whose simple abdominal X-ray is misinterpreted as having pneumobilia due to the presence of radiolucent areas in the liver parenchyma, leading to further unnecessary studies and increased morbidity.

Conclusion:

Being able to differentiate pneumobilia from portal gas y a challenge that requires close cooperation between clinicians and radiologists. Both circumstances can be related to pathologies with a wide range of severities and therefore, the integration of a diagnosis must be carefully complemented by the clinical scenario and the radiologic images.