Free Air: Signs to Watch Out for In Abdominal Imaging Part I

Pneumoperitoneum must be diagnosed promptly when it occurs, which is often abruptly and without warning.

Author: Stephen R. Baker, MD. Special Presentation for Practical Reviews in Radiology

The diagnosis of pneumoperitoneum or free air is a crucial diagnosis. Free air can be caused by a number of serious medical conditions, and appear in a number of different locations depending upon the underlying health condition.

Prompt recognition of free air by a radiologist can mean the difference between life and death.

Clinical information, while often helpful, can sometimes be misleading.

Thus, the observation of free air in the abdomen must be made by findings present on radiographic images alone.

Often the first study (and many times the only examination available to the radiologist) is a plain film of the abdomen, and often only a single view, such as a KUB, rather than that of the whole of the abdomen.

Because the stakes are so high, failure to diagnose a pneumoperitoneum may engender poor patient outcome and a possible malpractice suit.

Compared with other allegations of malpractice pertinent to the gastrointestinal tract, settlements and verdicts against the radiologist for missing free air are much more expensive.

Thus, it is crucial to become familiar with the range of plain film signs of free air, for prompt and accurate diagnosis of pneumoperitoneum.

This discussion will be presented in 2 subsequent parts, both concerned with the various manifestation of pneumoperitoneum as detected radiographically.

Summary of Part 1:

Pneumoperitoneum must be diagnosed promptly when it occurs, which is often abruptly and without warning.