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Chapter: Abdomen (Read entire chapter)

Subchapter: Air where it not belongs

Diagnosis: Free intraabdominal air - overview

X-ray: Up to 1 cc of free air detectable
Best view: upright or left lateral decubitus
Upright: air crescent under left hemidiaphragm, along diaphragmatic crux or between liver and right hemdiaphragm
Decubitus: Air between abdominal wall and bowel/right liver lobe
Supine view unreliable, may show RiglerĘs sign (air on both sides of bowel wall)
 

Pneumoperitoneum 2nd to:

Perforated viscus (peptic ulcer, diverticulitis appendicitis, toxic megacolon, intestinal infarction)
Neoplasm
Abscess
Iatrogenic (recent surgery/laparoscopy)

Cave!
Mimicker: Colon interposition, hiatal hernia