Dr Lilis,SpRad

 Air within the peritoneal cavity

 Most common cause is a perforated abdominal
viscus
 Causes of a pneumoperitoneum :
- Perforated peptic ulcer , necrotizing
enterocolitis, toxic megacolon, inflammatory
bowel disease
- Infection of the peritoneal cavity
- Iatrogenic factors : abdominal surgery,
abdominal trauma, leaking surgical anastomosis
- Bowel obstruction due to a neoplasm
- Pneumatosis intestinalis
Signs of a large pneumoperitoneum :

- The football sign

- The gas-relief sign, the Rigler sign, and
the double-wall sign
- Triangle sign represents a triangular
pocket of air between 2 loops of bowel and
the abdominal wall
- Free air under the diaphragm
air under the diaphragm
Upright chest radiograph shows a large

collection of air under both

hemidiaphragms
pneumoperitoneum outlining

the spleen and the superior

surface of the liver

Pneumoperitoneum

shows the falciform ligament (arrow

Pneumoperitoneum. Supine abdominal
radiograph shows a falciform ligament
(arrow).
Plate atelectasis at the right

lung base mimics a small

pneumoperitoneum.
Large bulla at the base of the right lung

mimics a large pneumoperitoneum.

Pneumoperitoneum, mimics.

Image shows colonic interposition.

Note the haustra.

 dilated loops of the small bowel

associated with thickened edematous

valvulae conniventes

Small-bowel obstruction
Upper GI barium series
distended jejunal loops

large laminated gallstone in

the right iliac fossa (arrow).

of a gallstone ileus.
Small-bowel obstruction

dilated loops of small bowel

multiple fluid levels in the small bowel

double-contrast barium enema

cecum suggestive of an intussusception

Hirschsprung disease. Frontal
abdominal radiograph showing marked
dilatation of the bowel with no gas in
the rectum.
Hirschsprung disease. Frontal abdominal

Radiograph showing marked dilatation

of the small bowel with no gas in the rectum.

Hirschsprung disease. Barium enema

Showing reduced caliber of the rectum,

followed by a transition zone to

an enlarged-caliber sigmoid
Barium enema showing reduced caliber

of the rectum, followed by a transition zone to

an enlarged-caliber sigmoid
Barium swallow study demonstrating
characteristics of achalasia, including the bird's
beak deformity and a dilated esophagus
Atrophic gastritis
Gastric ulcer with symmetrical,
radiating mucosal folds
Carcinoma of the cardia with

involvement of the distal esophagus

Annular carcinoma of the sigmoid colon

circumferential mass with mucosal

and the overhanging edges or shouldering

annular carcinomas in

the ascending colon

and splenic flexure.

Polypoid carcinoma of

the upper rectum

Annular carcinoma in

the upper rectum

Crohn disease. Aphthous ulcers.
Crohn disease

terminal ileum several narrowing

and stricturing
granular mucosa

Colitis ulcerative
pseudopolyposis of the descending

colon.Haustra menghilang

Colitis ulcerative
granular mucosa in the cecum/

ascending colon
Single-contrast barium enema study

shows ulcerative colitis.

the stone is seen as a relatively lucent

intravenous urogram
echogenic shadowing calculus in the renal collecting system with hydrone
Abdominal radiograph

calcification filling the left collecting system.

This finding is consistent with a staghorn ca

calcifications over the medullary region

of the left kidney in a patient

with nephrocalcinosis
moderately hydronephrotic

collectingsystem to the level of a

proximal ureteral stone (arrow)

Normal retrograde urethrogram
Retrograde urethrogram demonstrates a less common

type II urethral disruption. Extravasation of contrast

material
Straddle injury. Retrograde urethrogram
shows a type5 urethral injury with
extravasation of contrast material from the
distal bulbous urethra.
Conventional cystogram

demonstrating

an intraperitoneal bladder rupture.

intraperitoneal bladder rupture.
Thoracic spine trauma. Lateral

radiograph of the thoracic spine

with compression fracture (arrow)