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Case contributed by Dr Varun Babu


Acute onset abdominal pain.

Patient Data

Age: 45 years
Gender: Male

Chest - erect

Free air underneath the right diaphragm delineating the right diaphragm and liver margins.

There is also air underneath the central tendon of the diaphragm.

The visualized upper abdomen shows distended bowel loops.

Case Discussion

The presence of crescent lucency underneath the diaphragm is in keeping with pneumoperitoneum with limited differential diagnosis. There is also air underneath the central tendon of the diaphragm, which is similar to the cupola sign (seen on a supine radiograph) 1.

Pneumoperitoneum can be an ominous sign, in this case, it was due to bowel infarction and perforation.

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Case information

rID: 19474
Published: 13th Sep 2012
Last edited: 6th Jan 2021
Inclusion in quiz mode: Included

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