Type:
Educational Exhibit
Keywords:
Education, Conventional radiography, Thorax, Abdomen, Perception image, Education and training
Authors:
E. Ilieva; Sofia/BG
DOI:
10.1594/ecr2013/C-2590
Background
Pneumoperitoneum,
or air within the peritoneal cavity,
frequently indicates a perforated abdominal viscus that requires emergent surgical management.
Non-surgical spontaneous pneumoperitoneum (not associated with a perforated viscus) is an uncommon entity related to intrathoracic,
intra-abdominal,
gynecologic,
iatrogenic and other miscellaneous causes,
and is usually managed conservatively.
The most common thoracic causes include mechanical ventilation,
pneumomediastinum,
pneumothorax,
pre-existing pulmonary disease,
cardiopulmonary resuscitation.
For example,
mechanical ventilation with positive end-expiratory pressure (PEEP) may cause free air in the abdomen by alveolar rupture and subsequent air dissection into the mediastinum and peritoneal cavity.
Pneumoperitoneum could be easily missed when focused on the most obvious pathology on the chest X-ray,
or on supine radiographs even if the entire abdomen is filled with air.
Radiographic techniques:
- Supine abdominal view
- Supine decubitus abdominal view (optional)
- Right lateral decubitus view of the abdomen (optional)
- Patient lies with right side down,
left side up
- For patients unable/unwilling to adopt the left lateral decubitus position