Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Soto JA, Lucey BC. (2009). Emergency Radiology: The Requisites. Pg 305
Khan AN. (2014). Pneumoperitoneum Imaging. Medscape.
1-3) RUQ/Liver signs on supine AXR: 9) Double Bubble Sign
• Anterior Subhepatic Space Free Air
• Doges Cap Sign 10) Cupola Sign
• Air Anterior to Ventral Surface of Liver
11) Lesser Sac Gas
4) Rigler’s Sign
12) Triangle Sign
5) Decubitus Abdomen Sign
13) Abscess Gas
6) Falciform Ligament Sign
Index
• 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
• 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 →
becomes round ligament
– becomes
in a patient with free
abdominal gas
Index
• massively air-filled
peritoneum
Index
• massive
pneumoperitoneum
→ sufficient air
beneath the
diaphragm
• left & right
hemidiaphragms
contrasted by the
free gas appear as a
Index
• subdiaphragmatic gas
under the left
hemidiaphragm
– subdiaphragmatic free
gas (under black arrow)
– normal gas within the
fundus of the stomach
(under white arrow)
Index
• 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 haustral features
Index
• 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
Inverted V
Urachus Sign
Sign
Leaping Ligamentum
Dolphins Sign 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
– Adults: inferior epigastric
vessels
http://dx.doi.org/10.1148/radiology.151.1.6230689
Index
• 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 falciform ligament
Index
• 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