COTW February 1st, 2020

Written By William Swanson

A 60 year old woman presents to the ED with abdominal pain. She had an outpatient X-ray that was possibly abnormal. She is currently undergoing chemotherapy for metastatic colon colon cancer. She has abdominal tenderness, but no rigidity. Vitals are unremarkable.

Note the subtle free air on both the left and right side below the diaphragm.

Note the subtle free air on both the left and right side below the diaphragm.

You can often sit the patient up at 45 degrees or put them in reverse Trendelenburg to look for intraperitoneal air above the liver. You may see a small blip of free air at the tip of the liver near the end of the clip.

You can often sit the patient up at 45 degrees or put them in reverse Trendelenburg to look for intraperitoneal air above the liver. You may see a small blip of free air at the tip of the liver near the end of the clip.

Note the reverberation artifact (a-lines). Normally the abdominal ultrasound should not look like a lung ultrasound. This image is suspicious for pneumoperitoneum.

Note the reverberation artifact (a-lines). Normally the abdominal ultrasound should not look like a lung ultrasound. This image is suspicious for pneumoperitoneum.

*CAUTION*

Don’t get confused with gaseous distention (ileus, megacolon, Ogilve’s syndrome). These can present with distended loops of bowel filled with air mimicking pneumoperitoneum. Clinical context is key especially with a concerning/borderline chest x-ray.

William Swanson
Previous

COTW March 10, 2020: 65 y/o M with worsening dyspnea

Next

COTW December 21st