Published in:
01-02-2016 | Classics in Abdominal Imaging
The “double bubble” sign
Published in: Abdominal Radiology | Issue 2/2016
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The classic radiographic appearance of duodenal atresia—a gas-filled stomach with simultaneous dilated gas-filled proximal duodenum—has long been referred to as the “double bubble” sign. Initial radiographic reports detailing duodenal atresia described gaseous distention of the stomach and duodenum with an “hourglass” appearance [1], with later reports refining the description of duodenal obstruction to include the now classic “double bubble” moniker [2]. The larger gastric bubble occupies the left upper quadrant, with a smaller duodenal bubble in the right upper quadrant or right mid abdomen (Figs. 1, 2). The dilation reflects postnatal gas swallowing, with the atretic duodenal segment not allowing distal passage of swallowed gas.
Fig. 1
A “double bubble”
Fig. 2
Supine frontal radiograph of a neonate, with two gas-filled structures in the upper abdomen. The larger lucent structure in the left upper abdomen (black arrow) is the gas-distended stomach. The smaller lucent structure in the right mid abdomen represents gas in a distended proximal duodenum. Note the absence of distal bowel gas, a finding typical of duodenal atresia
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