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Ext. จริยาภรณ์ พัฒนกุลเลิศ
“ within the peritoneal cavity”
The most common cause is a perforation of the
abdominal viscus
– most commonly, a
Soto JA,...
1-3) RUQ/Liver signs on supine AXR:
• Anterior Subhepatic Space Free Air
• Doges Cap Sign
• Air Anterior to Ventral Surfac...
• Supine; RUQ/Liver sign 1
• Linear shape
Index
• Supine; RUQ/Liver sign 2
shaped
lateral
corner
border
outlining the medial
border of the liver
4. Positioned inferior to...
• Supine; RUQ/ Liver sign 3
• Uneven density in
Index
• Supine
• Bowel wall
(extraluminal = free
peritoneal gas)
of bowel wall
can be seen
(red arrows)
Index
• Left lateral
decubitus
• Air-fluid level
between
the abdominal
wall and the liver
in the
peritoneum
Index
• Supine
• Falciform ligament
– connects the anterior
abdominal wall to the
liver
– extends inferiorly
beyond the liver →
...
• massively air-filled
peritoneum
Index
• massive
pneumoperitoneum
→ sufficient air
beneath the
diaphragm
• left & right
hemidiaphragms
contrasted by the
free gas...
• subdiaphragmatic gas
under the left
hemidiaphragm
– subdiaphragmatic free
gas (under black arrow)
– normal gas within th...
• Air accumulation
beneath the central
tendon of the
diaphragm
Index
• The lesser sac
– positioned posterior to
the stomach
– usually a potential space
Note:
White arrow = Cupola sign
Index
• small triangles of free
gas positioned between
the large bowel and the
flank
Index
• arrowed
NOT clearly contained
within normal hollow
abdominal viscus
– NOT aligned in a linear
fashion nor outline
normal...
• Air seen surrounding
the lateral border of the
kidney (retroperitoneal
organs)
• If the gas is seen to
move in an erect ...
Urachus Sign
Inverted V
Sign
Leaping
Dolphins Sign
Ligamentum
Teres Sign
Index
• Air contrasted urachus
• Vertical line between
bladder and umbilicus
• Outline of medial
umbilical ligament
Index
• Supine
• Free air outlining the
, coursing
inferiorly and laterally
from the umbilicus
– Infants: umbilical
arteries
– A...
• Air under
hemidiaphragm and
diaphragmatic muscle
slips visible
Index
• Extraluminal air in the
fissure for the
Ligamentum Teres
• Linear density running
along the inferior edge of
the falcifo...
More Signs:
• Coronary Ligament Outlined by Air
– The coronary ligament sited anterior to the liver
• Pneumo-gall bladder
...
• Soto JA, Lucey BC. (2009). Emergency Radiology: The Requisites. Pg 305.
• Khan AN. (2014). Pneumoperitoneum Imaging. Med...
Signs of Pneumoperitoneum on Plain Film
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Signs of Pneumoperitoneum on Plain Film

14 signs of pneumoperitoneum on plain film

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Signs of Pneumoperitoneum on Plain Film

  1. 1. Ext. จริยาภรณ์ พัฒนกุลเลิศ
  2. 2. “ within the peritoneal cavity” The most common cause is a perforation of the abdominal viscus – most commonly, a Soto JA, Lucey BC. (2009). Emergency Radiology: The Requisites. Pg 305 Khan AN. (2014). Pneumoperitoneum Imaging. Medscape.
  3. 3. 1-3) RUQ/Liver signs on supine AXR: • Anterior Subhepatic Space Free Air • Doges Cap Sign • Air Anterior to Ventral Surface of Liver 4) Rigler’s Sign 5) Decubitus Abdomen Sign 6) Falciform Ligament Sign 7) Football Sign 8) Continuous Diaphragm Sign 9) Double Bubble Sign 10) Cupola Sign 11) Lesser Sac Gas 12) Triangle Sign 13) Abscess Gas 14) Pneumoretroperitoneum 15) Others
  4. 4. • Supine; RUQ/Liver sign 1 • Linear shape Index
  5. 5. • 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 Index
  6. 6. • Supine; RUQ/ Liver sign 3 • Uneven density in Index
  7. 7. • Supine • Bowel wall (extraluminal = free peritoneal gas) of bowel wall can be seen (red arrows) Index
  8. 8. • Left lateral decubitus • Air-fluid level between the abdominal wall and the liver in the peritoneum Index
  9. 9. • 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 gas Index
  10. 10. • massively air-filled peritoneum Index
  11. 11. • massive pneumoperitoneum → sufficient air beneath the diaphragm • left & right hemidiaphragms contrasted by the free gas appear as a Index
  12. 12. • subdiaphragmatic gas under the left hemidiaphragm – subdiaphragmatic free gas (under black arrow) – normal gas within the fundus of the stomach (under white arrow) Index
  13. 13. • Air accumulation beneath the central tendon of the diaphragm Index
  14. 14. • The lesser sac – positioned posterior to the stomach – usually a potential space Note: White arrow = Cupola sign Index
  15. 15. • small triangles of free gas positioned between the large bowel and the flank Index
  16. 16. • arrowed NOT clearly contained within normal hollow abdominal viscus – NOT aligned in a linear fashion nor outline normal haustral features Index
  17. 17. • 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 Index
  18. 18. Urachus Sign Inverted V Sign Leaping Dolphins Sign Ligamentum Teres Sign Index
  19. 19. • Air contrasted urachus • Vertical line between bladder and umbilicus • Outline of medial umbilical ligament Index
  20. 20. • 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.151.1.6230689 Index
  21. 21. • Air under hemidiaphragm and diaphragmatic muscle slips visible Index
  22. 22. • 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 Picture: DOI: 10.1056/NEJMicm0904627 Index
  23. 23. 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 Index
  24. 24. • Soto JA, Lucey BC. (2009). Emergency Radiology: The Requisites. Pg 305. • Khan AN. (2014). Pneumoperitoneum Imaging. Medscape. • Fuller MJ. (2011, May 27). Pneumoperitoneum. WikiRadiography. Website: http://www.wikiradiography.com/page/Pneumoperitoneum • Menuck L, Siemers PI. (1976). Pneumoperitoneum: Importance of Right Upper Quadrant Features. Am J Roentgeno. 127:753-756. • Weiner CI, Diaconis JN, Dennis JM. (1973, April). The “Inverted V”: A New Sign of Pneumoperitoneum. RSNA. Vol. 107, Issue 1. • Bray JF. (1984, April). The “inverted V” sign of pneumoperitoneum. RSNA. Vol. 151, Issue 1: 45-46. • Lee CH. (2010, June 24). Radiologic Signs of Pneumoperitoneum. N Engl J Med 2010; 362:2410. • Images in emergency medicine. Emerg Med J 2011;28:728 doi:10.1136/emj.2010.098699

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14 signs of pneumoperitoneum on plain film

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