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Pneumoperitoneum: importance of right upper quadrant features

L Menuck, P T Siemers

    AJR. American Journal of Roentgenology
    |November 1, 1976
    PubMed
    Summary

    Supine abdominal X-rays for pneumoperitoneum are often misinterpreted. Localized air in the right upper quadrant is the most common finding, requiring anatomical knowledge for accurate diagnosis.

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    Area of Science:

    • Radiology
    • Abdominal Imaging
    • Gastrointestinal Surgery

    Background:

    • Pneumoperitoneum, or free air in the abdominal cavity, is a critical finding often indicating surgical emergencies.
    • Traditional radiographic signs of pneumoperitoneum are well-documented but may not always be present or easily identifiable.

    Purpose of the Study:

    • To evaluate the frequency of specific radiographic findings in patients with confirmed pneumoperitoneum.
    • To identify the most common patterns of free intraperitoneal air on supine abdominal radiographs.

    Main Methods:

    • Retrospective review of 59 supine abdominal radiographs from patients with documented pneumoperitoneum.
    • Analysis of the presence and location of free intraperitoneal air, comparing findings to classic signs.

    Main Results:

    • Classic signs of pneumoperitoneum were observed in only 17% of cases.
    • Localized intraperitoneal air in the right upper quadrant was the most frequent finding, present in 49% of patients.
    • Accurate identification of air collections depended on understanding the anatomy of perihepatic spaces.

    Conclusions:

    • Supine abdominal radiography findings for pneumoperitoneum are often subtle and atypical.
    • Localized right upper quadrant air is a key indicator, necessitating detailed anatomical knowledge for interpretation.
    • Radiologists should be aware of these less common findings for timely diagnosis.

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