Pseudo-Rigler sign

Last revised by Bálint Botz on 12 Jan 2020

The pseudo-Rigler sign is an important form of pseudopneumoperitoneum, and a mimicker of the classic Rigler (double wall) sign, that can be encountered normally on abdominal radiographs.

Radiographic features

The pseudo-Rigler sign can result from omental or mesenteric fat, or oral contrast media outlining the bowel loops, or due to overlapping gas-filled bowels making the wall contours more striking 1-3

Practical points

If the radiological appearance is equivocal, then erect or lateral decubitus views, or increasingly a CT exam may verify or rule out the presence of free gas.

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Cases and figures

  • Figure 1: caused by bowel loop overlap
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