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Cupola sign

Last revised by Dr Daniel J Bell on 17 Dec 2021

The cupola sign is seen on a supine chest or abdominal radiograph in the presence of pneumoperitoneum

It refers to non-dependent gas that rises within the abdominal cavity of the supine patient to accumulate underneath the central tendon of the diaphragm in the midline. It is seen as lucency overlying the lower thoracic vertebral bodies. The superior border is well defined, but the inferior margin is not 1.

History and etymology

It was first described in 1986 by Robert Mindelzun (fl. 2021) and James McCort (1913-2006) who were both radiologists at Stanford University in California 2.

Cupola is an architectural term, referring to a small dome, in particular, one crowning a roof or turret 3. The word itself is borrowed from the Italian word cupola, which derived from the Late Latin word cupula meaning small cask, a diminutive formation from the Latin word "cupa" meaning barrel 4.

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3: duodenal injury
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