Pneumoperitoneum by ultrasonography: clinical imaging

Excerpt

A 65-year-old woman presented to emergency department with progressing abdominal pain since yesterday. She used the ED for palliative therapy (receiving analgesics). Her past medical history was significant for uterine leiomyosarcoma with metastatic lesions in the liver for which she had a total abdominal hysterectomy without chemotherapy. On her physical examination, she had BP = 80/50 mmHg, PR = 100 beats/min with a low-grade fever. She had abdominal distention due to ascites with generalized abdominal tenderness. Due to her worrisome vital signs, she was brought to the resuscitation CPR room. Cardiac monitoring and IV fluid therapy were started. To assess her volume status, ultrasonography was used to evaluate her IVC diameter and collapsibility. On sagittal sonographic of right upper quadrant by curvilinear probe, reverberation artefacts and enhanced peritoneal stripes were seen, which signified intraperitoneal-free air (Fig. 1). Chest X-ray study (Fig. 2) and abdominal pelvic CT scan confirmed this diagnosis (Fig. 3). At laparotomy, she was found to have peritonitis and a sigmoid perforation.

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