Pneuperitoneum is best discovered on Abdominal Radiograph. These signs help in easy detection of the condition

1. Please visit www.jssmcradiology.com
for more radiology education

2.  Supine; RUQ/Liver sign 1
 Linear shape
Please visit www.jssmcradiology.com for more
radiology education

3.  Supine; RUQ/Liver sign 2
shaped
lateral
corner
border outlining the
medial border of the
liver
4. Positioned inferior to
the 11thrib
5. Positioned superior
to the right kidney
Morrison’s pouch =
a potential space between
the right kidney & the liver
Please visit www.jssmcradiology.com for more
radiology education

4.  Supine; RUQ/ Liver sign 3
 Uneven density in
Please visit www.jssmcradiology.com for more
radiology education

5.  Supine
 Bowel wall
(extraluminal = free
peritoneal gas)
of bowel
wall can be seen
(red arrows)
Please visit www.jssmcradiology.com for more
radiology education

6.  Left lateral
decubitus
 Air-fluid level
between
the abdominal
wall and the liver
in the
peritoneum
Please visit www.jssmcradiology.com for more
radiology education

7.  Supine
 Falciform ligament
 connects the anterior
abdominal wall to the
liver
 extends inferiorly
beyond the liver →
becomes round
ligament
 becomes
in a patient
with free abdominal
gasPlease visit www.jssmcradiology.com for more
radiology education

8.  massively air-filled
peritoneum
Please visit www.jssmcradiology.com for more
radiology education

9.  massive
pneumoperitoneum
→ sufficient air
beneath the
diaphragm
 left & right
hemidiaphragms
contrasted by the
free gas appear as a
Please visit www.jssmcradiology.com for more
radiology education

10.  subdiaphragmatic gas
under the left
hemidiaphragm
 subdiaphragmatic
free gas (under black
arrow)
 normal gas within the
fundus of the stomach
(under white arrow)
Please visit www.jssmcradiology.com for more
radiology education

11.  Air accumulation
beneath the central
tendon of the
diaphragm
Please visit www.jssmcradiology.com for more
radiology education

12.  The lesser sac
 positioned posterior to
the stomach
 usually a potential
space
Note:
White arrow = Cupola
sign
Please visit www.jssmcradiology.com for more
radiology education

13.  small triangles of free
gas positioned
between the large
bowel and the flank
Please visit www.jssmcradiology.com for more
radiology education

14.  arrowed
NOT clearly contained
within normal hollow
abdominal viscus
 NOT aligned in a linear
fashion nor outline
normal haustral features
Please visit www.jssmcradiology.com for more
radiology education

15.  Air seen surrounding
the lateral border of
the kidney
(retroperitoneal
organs)
 If the gas is seen to
move in an erect and
decubitus view, it's
in the
retroperitoneum
Please visit www.jssmcradiology.com for more
radiology education

16. Urachus Sign
Inverted V
Sign
Leaping
Dolphins Sign
Ligamentum
Teres Sign
Please visit www.jssmcradiology.com for more
radiology education

17.  Air contrasted
urachus
 Vertical line between
bladder and umbilicus
 Outline of medial
umbilical ligament
Please visit www.jssmcradiology.com for more
radiology education

18.  Supine
 Free air outlining the
, coursing
inferiorly and laterally
from the umbilicus
 Infants: umbilical
arteries
 Adults: inferior
epigastric vessels
http://dx.doi.org/10.1148/radiology.151.1.62306
89
Please visit www.jssmcradiology.com for more
radiology education

19.  Air under
hemidiaphragm and
diaphragmatic muscle
slips visible
Please visit www.jssmcradiology.com for more
radiology education

20.  Extraluminal air in the
fissure for the
Ligamentum Teres
 Linear density running
along the inferior edge of
the falciform ligament
Emerg Med J 2011;28:728
doi:10.1136/emj.2010.098699
Please visit www.jssmcradiology.com for more
radiology education

21. More Signs:
 Coronary Ligament Outlined by Air
 The coronary ligament sited anterior to the liver
 Pneumo-gall bladder
 Air in the gall bladder fossa outlining the gall
bladder
Please visit www.jssmcradiology.com for more
radiology education

22. Please visit www.jssmcradiology.com
for more radiology education.
You can contribute for the collection
by email to jssmcrad@gmail.com