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Case Reports
. 2017 May 4;3(4):20160146.
doi: 10.1259/bjrcr.20160146. eCollection 2017.

Sonographic detection of pneumoperitoneum

Marlom Khor  1 , Joshua Cutten  2 , Joel Lim  2 , Yuranga Weerakkody  2
Affiliations
Case Reports

Sonographic detection of pneumoperitoneum

Marlom Khor et al. BJR Case Rep. .

Abstract

Accurate and timely detection of a perforated hollow viscus is crucial and has profound consequences for the patient with an acute abdomen. While a CT scan can provide an accurate diagnosis, the increasingly indiscriminate use of this modality sparks concern regarding radiation dosing, its associated safety concerns and its timely occurrence. There are distinct and readily reproducible findings of pneumoperitoneum on ultrasound. However, sonographers should be trained to detect pneumoperitoneum or patients may be discharged with false-negative results. This case report supports such a view and investigates the current literature surrounding this issue.

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Figures

Figure 1.
Figure 1.
A midsagittal image documenting a partially distended urinary bladder, with dependant-free fluid in the pelvis.
Figure 2.
Figure 2.
Sagittal image of the liver through segments 8 and 5. The peritoneal stripe sign can be appreciated obscuring the superior aspect of segment 8. There was no appearance of gallstones and Murphy’s sign was negative on ultrasound probe pressure.
Figure 3.
Figure 3.
A sagittal image documented through segments 4a, 4b and 1. The peritoneal stripe sign has been indicated. This image is the most convincing because it is taken in the midline—clear of ribs, bowel and lung artefactual distortions.
Figure 4.
Figure 4.
A PA erect chest x-ray; confirming the ultrasound findings and the presence of subdiaphragmatic free air (pneumoperitoneum).
See this image and copyright information in PMC

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