PowerPoint Presentation
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Signs in Pneumoperitoneum:
1) Anterior Subhepatic Space Free Air
Supine; RUQ/Liver sign 1Linear shape
Compared with normal fat density
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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
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3) Air Anterior to Ventral Surface Liver
Supine; RUQ/ Liver sign 3Uneven density in geographical shape
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4) Riglers Sign
SupineBowel wall outlined by intraluminal & extraluminal air (extraluminal = free peritoneal gas)Both sides of bowel wall can be seen(red arrows)
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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
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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
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7) The Football Sign
massively air-filled peritoneum
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8) Continuous Diaphragm Sign
massive pneumoperitoneum sufficient air beneath the diaphragmleft & right hemidiaphragms contrasted by the free gas appear as a continuous structure
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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)
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10) The Cupola Sign
Dome-likeAir accumulation beneath the central tendon of the diaphragm
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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
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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
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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
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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
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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
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Others: Leaping Dolphins Sign
Air under hemidiaphragm and diaphragmatic muscle slips visible
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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
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