Signs in pneumoperitoneum

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Signs in Pneumoperitoneum:

1) Anterior Subhepatic Space Free Air

Supine; RUQ/Liver sign 1Linear shape

Compared with normal fat density


2) Doges Cap Sign/ Morrisons Pouch Free Gas

Supine; RUQ/Liver sign 2Triangular shaped Sharp lower lateral corner Concave lateral border outlining the medial border of the liver Positioned inferior to the 11thrib Positioned superior to the right kidney

Morrisons pouch =a potential space between the right kidney & the liver


3) Air Anterior to Ventral Surface Liver

Supine; RUQ/ Liver sign 3Uneven density in geographical shape


4) Riglers Sign

SupineBowel wall outlined by intraluminal & extraluminal air (extraluminal = free peritoneal gas)Both sides of bowel wall can be seen(red arrows)


5) Decubitus Abdomen Sign

Left lateral decubitusAir-fluid levelWhite arrow = free air between the abdominal wall and the liverBlack arrow = free fluid in the peritoneum


6) Falciform Ligament Sign

SupineFalciform ligamentconnects the anterior abdominal wall to the liverextends inferiorly beyond the liver becomes round ligamentbecomes outlined with air in a patient with free abdominal gas


7) The Football Sign

massively air-filled peritoneum


8) Continuous Diaphragm Sign

massive pneumoperitoneum sufficient air beneath the diaphragmleft & right hemidiaphragms contrasted by the free gas appear as a continuous structure


9) Double Bubble Sign

subdiaphragmatic gas under the left hemidiaphragm2 collections of overlapping gassubdiaphragmatic free gas (under black arrow)normal gas within the fundus of the stomach (under white arrow)


10) The Cupola Sign

Dome-likeAir accumulation beneath the central tendon of the diaphragm


11) Lesser Sac Gas

The lesser sacpositioned posterior to the stomachusually a potential space

Note:White arrow = Cupola signPlease visit www.jssmcradiology.com for more radiology education

12) The Triangle Sign

small triangles of free gas positioned between the large bowel and the flank


13) Abscess Gas

arrowed bubbles of gas NOT clearly contained within normal hollow abdominal viscusNOT aligned in a linear fashion nor outline normal haustral features


14) Pneumoretroperitoneum

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 NOT in the retroperitoneum


Other Signs of PneumoperitoneumPlease visit www.jssmcradiology.com for more radiology education

Others: Urachus Sign

Air contrasted urachusVertical line between bladder and umbilicusOutline of medial umbilical ligament


Others: The Inverted V Sign

SupineFree air outlining the lateral umbilical ligaments, coursing inferiorly and laterally from the umbilicusInfants: umbilical arteriesAdults: inferior epigastric vesselshttp://dx.doi.org/10.1148/radiology.151.1.6230689


Others: Leaping Dolphins Sign

Air under hemidiaphragm and diaphragmatic muscle slips visible


Others: Ligamentum Teres Sign

Extraluminal air in the fissure for the Ligamentum TeresLinear density running along the inferior edge of the falciform ligament

Emerg Med J 2011;28:728 doi:10.1136/emj.2010.098699Please visit www.jssmcradiology.com for more radiology education

More Signs:Coronary Ligament Outlined by Air The coronary ligament sited anterior to the liverPneumo-gall bladderAir in the gall bladder fossa outlining the gall bladderPlease visit www.jssmcradiology.com for more radiology education

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

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Signs in pneumoperitoneum

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Transcript of Signs in pneumoperitoneum