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Age: 1 week (born at 24 weeks)

Sex: Male

Indication: Abdominal distension

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Case #10


Findings

  • Pneumoperitoneum
  • Featureless appearance of nondilated loops of bowel in the central abdomen
  • Symmetric mild bilateral pulmonary expansion with mild atelectasis in the right upper lobe
  • Endotracheal tube is positioned with tip projecting 3 mm above the carina
  • Gastric tube overlies the left upper quadrant
  • Umbilical venous catheter tip projects near the inferior cavoatrial junction
  • Umbilical arterial catheter tip at the level of T6


Diagnosis

  • Pneumoperitoneum

Sample Report

Pneumoperitoneum, raising concern for bowel perforation. Recommend surgical evaluation.

Likely lung disease of prematurity.


Discussion

  • Some  radiographic findings of pneumoperitoneum include:
    • Football sign – generalized hyperlucency of the abdomen with the falciform ligament resembling the lacing of a football
    • Rigler’s sign – gas along bowel walls makes both the inner and outer margins of the wall visible
    • Continuous appearance of the diaphragm (remember that pneumomediastinum can also do this)



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