Pseudopneumoperitoneum

Case contributed by Dr Daniel J Bell

Presentation

Abdominal pain and fullness, with no bowel opening for 3 weeks

Patient Data

Age: 20 years
Gender: Male
X-ray

Erect CXR

Dilated gas-filled large bowel loops are visible under the diaphragm, mimicking the continuous diaphragm sign of pneumoperitoneum. A CXR performed two years prior demonstrates a very similar appearance.

X-ray

Erect CXR (2 years earlier)

This chest radiograph was performed two years earlier with a very similar appearance.

Case Discussion

These CXRs are nice examples of pseudopneumoperitoneum. Chilaiditi sign is also present, i.e. interposition of colon between the liver and the diaphragm. It is only called Chilaiditi syndrome if the patient is symptomatic due to the interposing colon. 

This does not represent the continuous diaphragm sign as:

  1. the diaphragmatic contour is too thick to be diaphragm alone, rather it is due to bowel wall apposing the diaphragm 
  2. haustra are seen crossing the subdiaphragmatic gas, indicating it is large bowel
  3. no change from two years earlier
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Case information

rID: 63936
Published: 25th Oct 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: North Middlesex University Hospital

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