Gastrointestinal perforation x-ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Gastrointestinal perforation Microchapters
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Overview

Chest imaging

• Findings of chest x-ray in esophageal perforation include:

• Pneumomediastinum
• Ring-around-the-artery sign in cases of pneumomediastinum: gas around pulmonary artery and main branches
• Widening of the mediastinum
• Free air under the diaphragm on upright films
• Pleural effusion
• Abnormal cardiomediastinal contour

Abdominal imaging

Findings of abdominal x-ray in esophageal perforation include:

• Free gas under the diaphragm is a classic sign of pneumoperitoneum on erect chest.
• Cupola sign is an arcuate lucency over the lower thoracic spine.
• Rigler sign is seen as gas outlines the inner and outer surfaces of the intestine.
• Psoas sign is air in the retroperitoneal space outlining the psoas muscle.
• Urachus sign is air in the preperitoneal space outlining the urachus or umbilical ligaments.

Neck imaging

Signs of perforation on plain neck imaging include:

• Subcutaneous emphysema tracking into the neck
• Anterior displacement of the trachea
• Air in the prevertebral fascial planes on lateral view

X-ray abdomen and chest shows bowel perforation,source: Case courtesy of Dr Rahul Kulkarni, Radiopaedia.org, rID: 21444

Intestinal obstruction x-ray, source: Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 35721