This document discusses pneumoperitoneum, which refers to free gas in the peritoneal cavity. It can be caused by a perforated abdominal viscus and is a medical emergency. The best way to detect free intraperitoneal air is with an upright chest x-ray. There are several signs visible on imaging that can indicate the presence of pneumoperitoneum, including air in the subhepatic space, Morrison's pouch, or beneath the diaphragm. The case review describes a patient presenting with abdominal pain and distention who is found to have pneumoperitoneum on chest x-ray.

1. Pneumoperitoneum

2. INTRODUCTION:
Pneumoperitoneum refers to the presence of free
gas within the peritoneal cavity. The plain films
signs of pneumoperitoneum are both diverse and
sometimes difficult to identify.
Pneumoperitoneum is most often caused by
perforated abdominal viscus and can present an
acute medical emergency.

4. “The Radiological signs of pneumoperitoneum
are among the most important signs in
radiology, indeed in Medicine. Sometimes the
amount of free gas is small and you may have
to work to demonstrate it (i.e. modify the film
technique). Miss it and the patient may die”

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11. CASE REVIEW

12. A 51-year-old man presented to the ED with progressive
abdominal pain of one day's duration. He had not
eaten all day and had vomited twice. There was no
associated diarrhea or melena.
He had a history of alcoholic hepatitis, COPD, and
surgical repair of a colonic-bladder fistula 10 years
earlier. He had mild constipation and abdominal
discomfort for the past few months.
On examination, the patient was in moderate distress
due to abdominal pain. Vital signs: blood pressure
130/70 mm Hg; pulse 118 beats/min; respirations 24
breaths/min; temperature 100.8º F (rectal).
His abdomen was distended but soft, with mild diffuse
tenderness and no rebound tenderness. His stool was
negative for occult blood. He was anicteric

14. The best radiographic view for detecting free
intraperitoneal air is the upright chest radiograph

20. Look 4 air
• Anterior subhepatic space free air
• Morrison’s pouch
• Air anterior to ventral surface of liver
• Decubitus abdomen sign
• Rigler’s sign on supine
• Falciforme ligament sign
• The “football “signe Air

21. • Continuous Diaphragm sign
• Double bubble sign
• The Cupola sign
• Lesser sac gas
• The triangle sign
• Pneumoretroperitoneum

22. RUQ LIVER SIGNS

27. DECUBITUS ABDOMEN SIGN

28. RIGLER’S SIGN SUPINE AXR

29. FALCIFORME LIGAMENT SIGN

30. THE FOOTBALL SIGN

31. CONTINUOUS DIAPHRAGM SIGN

32. THE DOUBLE BUBBLE SIGN

33. CUPOLA SIGN

34. THE TRIANGLE SIGN

35. NEUMORETROPERITONEO

36. “We diagnose what we look for
and look for what we know”