Published in:
01-02-2017 | Classics in Abdominal Imaging
The leaping dolphin sign
Published in: Abdominal Radiology | Issue 2/2017
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The multitude of radiologic signs purporting to reveal pneumoperitoneum on supine abdominal radiographs attests to the difficulty of making the diagnosis [1‐4]. The “leaping dolphins” sign offers a particularly exotic metaphorical example, describing intraperitoneal free air beneath the arcuate slips of the diaphragm’s long costal muscles [1, 3]. The gently curving collections of gas mimicking the parallel arcs of dolphins leaping in tandem (Fig. 1) occur more often in the right upper quadrant (Fig. 2), but occasionally can be seen on the left. This sign usually indicates a moderate to large volume pneumoperitoneum, and so, it most often accompanies at least one additional sign of free air (Fig. 3) [1, 2, 4].
Fig. 1
Leaping dolphins
(This copyrighted picture of leaping dolphins is used with permission of the photographer, Mr. Doug Perrine)
Fig. 2
Parallel arcuate collections of gas beneath the long costal muscle slips of the diaphragm reprise the “leaping dolphins” in the right upper quadrant on this coned-down, supine abdominal radiograph (yellow arrows)
Fig. 3
Supine radiograph of another patient with a right upper quadrant “leaping dolphin” (yellow arrows). Note the additional signs of free air, including Rigler’s double wall sign (white arrow), the cupola sign (blue arrow), and the lucent liver
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