Pneumatosis is frequently a dire finding, indicating bowel necrosis in the setting of bowel ischemia. However, it can be a benign finding in the setting of COPD, ventilation, automimmune diseases such as SLE, certain medications (i.e. steroids, and immunosuppressives)and after endoscopy. Benign causes of pneumatosis tend to cause cystic air bubbles, while the more concerning underlying processes often cause linear air collections, but the primary differentiation if clinical.