Freie abdominelle Luft
Röntgen-Übersichtsaufnahme
des Abdomen in Rückenlage bei massiv freier Luft intraperitoneal. Man erkennt die Kontrastierung der Darmwand von luminal (innen) und peritoneal (außen): Rigler-Zeichen.
Pneumoperitoneum
im Thoraxbild. Die freie "Luft" ist zwischen dem Oberrand der Leber (rote Pfeile) und dem Zwerchfell (grüne Pfeile) zu erkennen. Die blauen Pfeile zeigen auf den gasgefüllten Dickdarm (normal).
Freie Luft im
Abdomen nach PEG-Anlage. In der Seitenlage ist die Luft neben der Leber nicht zu übersehen.
Premature
newborn with respiratory distress syndrome and new abdominal distension on a ventilatorAXR cross-table lateral shows a distended abdomen with a huge amount of air between the anterior abdominal wall and the abdominal organs.The diagnosis was pneumoperitoneum in a patient with respiratory distress syndrome.
Premature
newborn after nasogastric tube placementSupine and left lateral decubitus AXR (left) show a nasogastric tube with its tip deep in the pelvis without evidence of free air. Supine AXR taken after pulling the nasogastric tube back into the stomach (above right) shows increased lucency throughout the central abdomen and left lateral decubitus AXR taken at same time (below right) shows air between the abdominal wall and the liver.The diagnosis was pneumoperitoneum due to gastric perforation during nasogastric tube placement which became visible only after the nasogastric tube was pulled out of the hole it had made in the stomach wall.
Newborn with
distended abdomen after nasogastric tube placementSupine AXR (left) shows a large amount of air within the abdomen and air outlining both sides of bowel wall (Rigler’s sign) in the right lower quadrant. Supine AXR taken later after pulling back of the nasogastric tube out of the stomach shows visualization of the falciform ligament over the spine (American football sign)The diagnosis was pneumoperitoneum due to gastric perforation during nasogastric tube placement.
Premature
newborn with abdominal distension after nasogastric tube placementSupine AXR (above) shows increased lucency in the upper abdomen. The cross-table lateral AXR (below) shows air between the anterior abdominal wall and the bowel. The nasogastric tube follows a very straight course and does not curve towards the stomach. Note on both views that the tip of the nasogastric tube does not project over the stomach. US performed subsequently showed the tip of the nasogastric tube was in the retroperitoneum and not in the stomach.The diagnosis was perforation of the esophagus during nasogastric tube placement. In the operating room the pneumoperitoneum was found to be due to an ileal perforation.
Newborn with
esophageal atresia with abdominal distension after gastrostomy tube placement 1 week agoSupine AXR (left) shows a gastrostomy tube projecting appropriately over the stomach with a triangular lucency superior to the stomach. Left lateral decubitus AXR (above right) again shows the triangular lucency superior to the stomach but does not show air between the abdominal wall and liver. Cross-lateral AXR (below right) shows air between the anterior abdominal wall and liver. The diagnosis was pneumoperitoneum due to gastric perforation after gastrostomy placement. In the operating room the patient was found to have ischemic necrosis of the greater curvature of the stomach.
Premature
newborn with abdominal distensionSupine AXR shows increased lucency in the upper abdomen with clear demonstration of the football sign of the falciform ligament being outlined by free air.The diagnosis was pneumoperitoneum.
Premature
newborn on ventilator with abdominal distensionCross-table lateral AXR shows a large amount of free air superiorly in the abdomen outlining some of the bowel loops and compressing the rest posteriorly.The diagnosis was pneumoperitoneum.
Preschooler
with abdominal pain. Upright CXR shows free air beneath the diaphragm. The diagnosis was pneumoperitoneum.
Dünndarmperforation
bei inkarzerierter Narbenhernie. Massiv freie intraabdominelle Luft mit Rigler-Zeichen in der Linkseitenlage gut zu sehen. Ileussituation. Es musste Dünndarm reseziert werden.
Riglerzeichen
bei freier Luft: Die Darmwand ist vor allem im Bereich der rechten Kolonflexur von innen und außen durch Luft kontrastiert.
Freie Luft im
Abdomen nach PEG-Anlage. In Rückenlage erkennt man die flächige Hypertransparenz und am Kolonrahmen das typische Rigler-Zeichen mit Kontrastierung der Darmwand von innen und aussen.
Pneumoperitoneum
("freie Luft") in der Röntgenaufnahme des Abdomens in linker Seitenlage. Man erkennt den Leberrand (rote Pfeile), die Gasblase in der Bauchhöhle (grüne Pfeile) und einen Luft-Flüssigkeits-Spiegel (blaue Pfeile).
Pneumoperitoneum
bei Sigmaperforation (iatrogen). Rigler-Zeichen: Luft an beiden Seiten der Darmwand. Hier jedoch sicher nicht zu übersehen.
Pneumoperitoneum
bei Sigmaperforation (iatrogen). Rigler-Zeichen: Luft an beiden Seiten der Darmwand. Hier jedoch sicher nicht zu übersehen.
Perforation
bei einer Koloskopie: Massiv freie Luft in der Bauchhöhle und sogar Austritt in die Weichteile der Bauchwand.
Perforation
bei einer Koloskopie: Massiv freie Luft in der Bauchhöhle und sogar Austritt in die Weichteile der Bauchwand.
A case of
complicated emphysematous cholecystitis. Direct signs of pneumoperitoneum secondary to gallbladder perforation: free air in the right subdiaphragmatic space.
Pneumoperitoneum
from an insufficient intestinal anastomosis. Hardly to see in this image, but see CT.
Subdiaphragmatic free gas is one of the ways of detecting presence of free intraperitoneal gas (i.e. pneumoperitoneum). It is the presence of free, extraluminal gas in the anterior subhepatic space.
Radiographic features
Plain radiograph
Subdiaphragmatic free gas is well appreciated as the gas under the diaphragm and air in the lungs outline the diaphragmatic contour well.
As little as 1 mL of free gas can be detected but the patient may be needed to be kept in upright position for about 10 minutes for the gas to rise.
Erect chest x-rays covering the upper abdomen are often considered the best for detecting free subdiaphragmatic gas but an erect abdominal x-ray covering the lung bases will be just as sensitive.
When there is a large amount of free subphrenic gas the continuous diaphragm sign may be present.
Differential diagnosis
- Chilaiditi sign/syndrome
- subdiaphragmatic abscess
- omental fat interposed between the liver and diaphragm
- subpulmonary pneumoperitoneum
- enlarged gastric bubble
- gas-containing liver hematoma
See also
Siehe auch:
- Pneumothorax
- Rigler-Zeichen
- Appendizitis Bildgebung
- Fremdkörper
- Divertikulitis
- pseudopneumoperitoneum
- peritoneal cavity
- Mesenterialinfarkt
- mechanischer Ileus
- Mediastinalemphysem
- Chronisch-entzündliche Darmerkrankungen
- Magenulkus
- Nekrotisierende Enterokolitis
- tension pneumoperitoneum
- Linksseitenlage
- abnormales Gas im Abdomen
- football sign
- retropneumoperitoneum
- cupola sign
- Pneumoperitoneum beim Neugeborenen
und weiter:
- continuous diaphragm sign
- falciform ligament sign
- retroperitoneal gas
- emphysematöse Cholezystitis
- Chilaiditisyndrom
- Magenperforation
- jejunal perforation following blunt abdominal trauma
- Überblähung nach Endoskopie
- traumatic jejunal perforation
- necrotising enterocolitis staging
- post-operative pneumoperitoneum
- Pneumatosis intestinalis bei immunsupprimierten Patienten
