Presentation
Pelvic trauma. Acuteness shortness of breath and drop in oxygen saturation.
Patient Data
There is the appearance of free gas under the left hemidiaphragm. There is a paucity of vascular markings in both lungs, concerning for bilateral pulmonary emboli in this context. This was confirmed on subsequent CT. Heart size is within normal limits for AP projection.
CT does not show any free intraperitoneal gas.
Comminuted fracture involving the left acetabulum extending from the superior ramus of the pubis to the ala of the ilium. There is also a minimally displaced fracture of the left ischial ramus. Mild extra-peritoneal fat stranding in the left aspect of the pelvis near the fractures. The presacral space is obliterated by a collection of intermediate attenuation that may represent an hematoma. Free blood is present in the pelvis and both inguinal canals. The liver, spleen, pancreas, and adrenal glands are normal. Kidneys have normal size and cortical thickness, showing bilateral parapelvic cysts. 6.0 mm stone in the left lower pole. No hydronephrosis. No other abnormality of the bowel is identified. There is intraperitoneal free fluid or free gas. No lymph node enlargement.
Case Discussion
Pseudopneumoperitoneum, as in this case, describes any gas within the abdominal cavity that masquerades as free intraperitoneal gas or pneumoperitoneum when it is in fact contained within an organ.
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