Acute onset abdominal pain
Erect chest radiograph
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Free air underneath the right diaphragm. There is also air underneath the central tendon of the diaphragm, which is similar to the cupola sign (seen on a supine radiograph).
Penumoperitoneum can be an ominous sign, in this case it was due to bowel infarction and perforation
- Kasznia-Brown J, Cook C. Radiological signs of pneumoperitoneum: a pictorial review. Br J Hosp Med (Lond). 2007;67 (12): 634-9. Pubmed citation