LAST CHANCE: X-ray Interpretation: Elbow Injuries - Half price course offer ends this Sunday!


Pneumoretroperitoneum is by definition presence of gas within the retroperitoneal space.

Pneumoretroperitoneum is always abnormal and has a relatively small differential:

If localized, and especially in the presence of an air-fluid level, a retroperitoneal abscess should be suspected.

Pneumoretroperitoneum is best appreciated by CT, however, can also be detected by plain abdominal radiograph and even by transabdominal ultrasound. Generally, the air is most commonly seen surrounding the kidneys in the right and left upper quadrants of the abdomen 6. There may also be a loss of the normal psoas muscle shadow 6.

Interfaces between free air and soft tissues appear as echogenic lines with posterior reverberation artifacts and the obscuration of far-field structures. In pneumoretroperitoneum air will collect around the following structures 10:

  • right kidney
  • great vessels
    • the disappearance of the retroperitoneal inferior vena cava and abdominal aorta 9
  • head of the pancreas
  • gallbladder
    • retroperitoneal air will collect posteriorly 
  • duodenum

On plain radiography, the differential is that of gas in other spaces which also projects over the abdomen. It thus includes:

CT has little difficulty in distinguishing these.

Article information

rID: 6167
Synonyms or Alternate Spellings:
  • Retroperitoneal gas
  • Retropneumoperitoneum

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: post ERCP
    Drag here to reorder.
  • Case 2
    Drag here to reorder.
  • Case 3: post colonoscopy
    Drag here to reorder.
  • Case 4
    Drag here to reorder.
  • Case 5
    Drag here to reorder.
  • Case 6
    Drag here to reorder.
  • Case 7: post ERCP
    Drag here to reorder.
  • Case 8: emphysematous pyelonephritis
    Drag here to reorder.
  • Case 9
    Drag here to reorder.
  • Case 10: post ERCP
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.