eMedicine Specialties > Radiology > Gastrointestinal
Pneumoperitoneum: Multimedia
Updated: Jun 18, 2008
Multimedia
 | Media file 1: Pneumoperitoneum. Diagram of transverse section of the abdomen shows peritoneal reflection. |
 | Media file 2: Pneumoperitoneum. Diagram of a sagittal section of the female abdomen and pelvis shows peritoneal reflection. |
 | Media file 3: Pneumoperitoneum. Plain radiograph of the right upper quadrant shows a tiny streak of air under the diaphragm due to a pneumoperitoneum. |
 | Media file 4: Pneumoperitoneum. Upright chest radiograph shows a large collection of air under both hemidiaphragms due to perforated duodenal ulcer. |
 | Media file 5: Pneumoperitoneum. Upright chest radiograph shows a large pneumoperitoneum outlining the spleen and the superior surface of the liver. |
 | Media file 6: Pneumoperitoneum. Images in a 24-year-old man known to have Crohn disease who presented with acute abdominal pain. (Left) Supine radiograph of the right upper quadrant shows a vague lucency overlying the liver. (Right) Lateral decubitus radiograph shows an obvious pneumoperitoneum. Note also the air-fluid levels within the bowel due to associated ileus. At surgery, a perforated terminal ileum secondary to Crohn disease was diagnosed. |
 | Media file 7: Pneumoperitoneum. This elderly patient was knocked down by a car in a motor vehicle accident. Her main complaint was hip pain. Plain abdominal radiograph of the pelvis confirms the presence of a fracture of the neck of the left femur, but also note a bowel relief sign (arrow). At surgery, a perforation of the small bowel secondary to blunt abdominal trauma was confirmed. |
 | Media file 8: Pneumoperitoneum. Coned view of the lower abdomen shows the lateral umbilicus sign (arrow), which is a sign of a large pneumoperitoneum on a plain abdominal radiograph. Note also the bowel relief sign. |
 | Media file 9: Pneumoperitoneum. Coned view of the lower abdomen shows the urachus sign (arrows), which is another sign of a large pneumoperitoneum on a plain abdominal radiograph. |
 | Media file 10: Pneumoperitoneum. Diagrams of the right upper quadrant show the location of the oblong collection of air in the right subhepatic space seen on a plain supine abdominal radiograph. |
 | Media file 11: Pneumoperitoneum. Supine abdominal radiograph in the same patient as in Image 7 shows an elliptical collection of air within the subhepatic space. Note also the bowel relief sign. |
 | Media file 12: Pneumoperitoneum. Diagram of the right upper quadrant shows a triangle-shaped collection of air in the Morison pouch, as seen on a plain supine abdominal radiograph. This collection is usually bound by the 11th rib, and it may be triangular (doge's cap), crescent shaped, or semicircular. |
 | Media file 13: Pneumoperitoneum. Plain abdominal radiograph of a patient with a pneumoperitoneum shows a triangular collection of air in the Morison pouch (solid arrows). Also note the bowel relief sign (open arrows). |
 | Media file 14: Pneumoperitoneum. (Left) Supine chest radiograph shows a tiny collection of air under the diaphragm (arrow) in a patient with pneumoperitoneum. (Right) Supine abdominal radiograph shows a triangular collection of air in the Morison pouch (arrow). |
 | Media file 15: Pneumoperitoneum. Diagram of the right upper quadrant shows the location of a circular collection of air projected over the liver interposed between the anterior liver surface and the anterior thoracic and abdominal wall seen on a plain supine abdominal radiograph. |
 | Media file 16: Pneumoperitoneum. Contrast-enhanced axial CT scan through the liver shows a collection of air anterior to the liver, as depicted in the diagram in Image 15. Also note the air surrounding the gallbladder and the leakage of water-soluble contrast material from a perforated duodenal ulcer. |
 | Media file 17: Pneumoperitoneum. (Left) Sagittal sonogram through the liver shows a comet-shaped artifact due to free air in the anterior subphrenic space, which causes shadowing. Also note the free peritoneal fluid. (Right) A transverse oblique sonogram through the midabdomen shows dilated loops of small bowel with a streak of free fluid between the bowel loops. |
 | Media file 18: Pneumoperitoneum. A 66-year-old man was admitted to the hospital with urinary retention and was being examined for prostatic pathology. While he was in the ward, he had a sudden onset of acute abdominal pain. Findings on this supine radiograph were interpreted as being normal, but note the pear-shaped lucency projected over the liver indicative of a pneumoperitoneum (see also Images 19-20). |
 | Media file 19: Pneumoperitoneum. Scanogram obtained prior to CT in the same patient as in Image 17 shows the falciform ligament (arrow) and leakage of oral contrast medium (L) secondary to a pneumoperitoneum. |
 | Media file 20: Pneumoperitoneum. Nonenhanced axial CT through the tip of the liver in the same patient as in Images 18 and 19 show leakage of oral contrast material (arrows) from a perforated gastric ulcer. |
 | Media file 21: Pneumoperitoneum. A 49-year-old man was admitted to the hospital with acute abdominal pain. Findings from the initial plain abdominal radiographs were interpreted as being normal. Because the cause of his abdominal pain was not clear, an upper GI series performed with water-soluble contrast material was requested. (Left) Radiograph obtained early in the study shows no leakage, but note the triangular collection of air within the Morison pouch. (Right) When this earlier plain radiograph was interpreted, the collection of air within the Morison pouch was seen; this had escaped detection earlier (arrow). |
 | Media file 22: Pneumoperitoneum. Supine abdominal radiograph in a 26-year-old man with known Crohn disease who presented with acute abdominal pain. Findings on the initial plain radiographs were interpreted as normal. Radiograph shows barium within the stomach, but note air within the lesser sac and in the Morison pouch. At surgery, a perforated duodenal ulcer was confirmed. |
 | Media file 23: Pneumoperitoneum. Supine abdominal radiograph shows a falciform ligament (arrow). |
 | Media file 24: Pneumoperitoneum. (Left) Upper GI barium series in a patient who presented with acute abdominal pain. Note the duodenal ulcer crater and air within the ligamentum teres (arrow). (Right) Follow-up barium study shows that the barium leak and air within the ligamentum teres (arrow) persists. |
 | Media file 25: Pneumoperitoneum. Plain abdominal radiograph in a 24-year-old man who presented with acute abdominal pain 24 hours after undergoing an upper GI series with barium. Radiography was performed to evaluate peptic ulcer disease. Note that barium has been released into the anterior subphrenic space (arrows). Note also the delineation of the falciform ligament of the escaped barium. Also seen is barium within the grooves of mesenteric vessels (arrows). The bowel relief sign is obvious. |
 | Media file 26: Pneumoperitoneum. Left, Posteroanterior (PA) chest radiograph in a patient receiving long-term steroid therapy who presented with breathlessness but no abdominal symptoms. A large pneumoperitoneum is present, and because of the lack of abdominal signs, she was observed. (Right) Two weeks later, a repeat anteroposterior (AP) chest radiograph was obtained because the patient felt vaguely unwell, although she had no abdominal signs. Note the air-fluid level to the left of the upper lumbar spine and left basal pleural effusion. At surgery, a retroperitoneal abscess secondary to a colonic perforation was diagnosed. Patients who are diabetic or those taking steroids are prone to silent perforations. |
 | Media file 27: Pneumoperitoneum. This patient was unwell after endoscopic retrograde cholangiopancreatography (ERCP). Plain abdominal radiograph shows a falciform ligament (arrow) and the bowel relief sign. The patient was treated conservatively because of a lack of abdominal signs. He recovered fully. |
 | Media file 28: Pneumoperitoneum. Plain abdominal radiograph in a patient in whom a retropneumoperitoneum developed after endoscopic retrograde cholangiopancreatography (ERCP). |
 | Media file 29: Pneumoretroperitoneum. Chest radiograph (left) and plain radiograph (right) show surgical emphysema and retroperitoneal air secondary to a retroperitoneal bowel perforation. |
 | Media file 30: Pneumoperitoneum. Image shows bowel perforation after bowel infarction. Note the large pneumoperitoneum and air within the portal venous radicals. |
 | Media file 31: Pneumoperitoneum, mimics. Pneumatosis coli secondary to necrotizing enterocolitis. |
 | Media file 32: Pneumoperitoneum, mimics. Plate atelectasis at the right lung base mimics a small pneumoperitoneum. |
 | Media file 33: Pneumoperitoneum, mimics. Large bulla at the base of the right lung mimics a large pneumoperitoneum. |
 | Media file 34: Pneumoperitoneum, mimics. Image shows colonic interposition. Note the haustra. |
 | Media file 35: Pneumoperitoneum, mimics. Air-containing bowel loops within a Morgagni hernia. |
 | Media file 36: Pneumoperitoneum, mimics. Air within the portal venous radicals secondary to bowel infarction is an ominous sign in adult patients. |
 | Media file 37: Pneumoperitoneum, mimics. Image shows air within the biliary tree after papillotomy. |
 | Media file 38: Pneumoperitoneum: Posterior perforation of a duodenal ulcer showing inflammatory fluid around the gallbladder mimicking acute cholecystitis. |
More on Pneumoperitoneum |
| Overview: Pneumoperitoneum |
| Imaging: Pneumoperitoneum |
| Follow-up: Pneumoperitoneum |
 Multimedia: Pneumoperitoneum |
| References |
| « Previous Page |
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Further Reading
Keywords
perforated abdominal viscus, air in the peritoneal cavity, peritoneal air, perforated ulcer, peptic ulcer, pneumatosis coli
