2. ο Supine; RUQ/Liver sign 1
ο Linear shape
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3. ο Supine; RUQ/Liver sign 2
shaped
lateral
corner
border outlining the
medial border of the
liver
4. Positioned inferior to
the 11thrib
5. Positioned superior
to the right kidney
Morrisonβs pouch =
a potential space between
the right kidney & the liver
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4. ο Supine; RUQ/ Liver sign 3
ο Uneven density in
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5. ο Supine
ο Bowel wall
(extraluminal = free
peritoneal gas)
of bowel
wall can be seen
(red arrows)
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6. ο Left lateral
decubitus
ο Air-fluid level
between
the abdominal
wall and the liver
in the
peritoneum
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7. ο Supine
ο Falciform ligament
ο connects the anterior
abdominal wall to the
liver
ο extends inferiorly
beyond the liver β
becomes round
ligament
ο becomes
in a patient
with free abdominal
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9. ο massive
pneumoperitoneum
β sufficient air
beneath the
diaphragm
ο left & right
hemidiaphragms
contrasted by the
free gas appear as a
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10. ο subdiaphragmatic gas
under the left
hemidiaphragm
ο subdiaphragmatic
free gas (under black
arrow)
ο normal gas within the
fundus of the stomach
(under white arrow)
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11. ο Air accumulation
beneath the central
tendon of the
diaphragm
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12. ο The lesser sac
ο positioned posterior to
the stomach
ο usually a potential
space
Note:
White arrow = Cupola
sign
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13. ο small triangles of free
gas positioned
between the large
bowel and the flank
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14. ο arrowed
NOT clearly contained
within normal hollow
abdominal viscus
ο NOT aligned in a linear
fashion nor outline
normal haustral features
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15. ο Air seen surrounding
the lateral border of
the kidney
(retroperitoneal
organs)
ο If the gas is seen to
move in an erect and
decubitus view, it's
in the
retroperitoneum
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17. ο Air contrasted
urachus
ο Vertical line between
bladder and umbilicus
ο Outline of medial
umbilical ligament
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18. ο Supine
ο Free air outlining the
, coursing
inferiorly and laterally
from the umbilicus
ο Infants: umbilical
arteries
ο Adults: inferior
epigastric vessels
http://dx.doi.org/10.1148/radiology.151.1.62306
89
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19. ο Air under
hemidiaphragm and
diaphragmatic muscle
slips visible
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20. ο Extraluminal air in the
fissure for the
Ligamentum Teres
ο Linear density running
along the inferior edge of
the falciform ligament
Emerg Med J 2011;28:728
doi:10.1136/emj.2010.098699
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21. More Signs:
ο Coronary Ligament Outlined by Air
ο The coronary ligament sited anterior to the liver
ο Pneumo-gall bladder
ο Air in the gall bladder fossa outlining the gall
bladder
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