0:00

This next patient is an extremely premature infant

0:03

who is six days old, um, who presented with, um,

0:07

increased episodes of bradycardia, oxygen desaturation,

0:11

and abdominal distension.

0:13

Um, and it's clear to see why this abdomen is distended.

0:16

So this is a right lower extremity pic.

0:18

The tip is projecting over the IDC.

0:20

We have an enteric tube that is projecting, uh, kind

0:24

of over the mid, mid aspect of the, of the left abdomen.

0:27

So a little bit more inferiorly than we would expect

0:30

for just the gastric body.

0:31

And then we have lung disease of prematurity

0:33

with some superimposed atelectasis.

0:35

The most important finding

0:37

to make on this image is pneumoperitoneum

0:39

and it's large pneumoperitoneum.

0:41

We have a continuous diaphragm sign of air underneath the,

0:45

uh, um, diaphragm in the abdomen.

0:48

And then when we look closely

0:50

and we window our image,

0:51

we can see there is falciform ligament here.

0:53

So this is the football sign of, um, pneumoperitoneum.

0:58

Last but not least, this patient has a regular sign,

1:01

so we can see both sides of the, uh, of this loop

1:05

of bowel in the middle of the abdomen.

1:07

So we have gas within this loop of bowel,

1:09

but we also have gas up outside of this loop of bowel,

1:12

allowing us to see both sides of this loop of bowel.

1:14

So this is a regular sign.

1:16

So large volume pneumoperitoneum compatible

1:18

with intestinal perforation in this extremely premature, um,

1:22

almost one week old infants.

Case: Surgical Necrotizing Enterocolitis on X-ray

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0:00

This next patient is an extremely premature infant

0:03

who is six days old, um, who presented with, um,

0:07

increased episodes of bradycardia, oxygen desaturation,

0:11

and abdominal distension.

0:13

Um, and it's clear to see why this abdomen is distended.

0:16

So this is a right lower extremity pic.

0:18

The tip is projecting over the IDC.

0:20

We have an enteric tube that is projecting, uh, kind

0:24

of over the mid, mid aspect of the, of the left abdomen.

0:27

So a little bit more inferiorly than we would expect

0:30

for just the gastric body.

0:31

And then we have lung disease of prematurity

0:33

with some superimposed atelectasis.

0:35

The most important finding

0:37

to make on this image is pneumoperitoneum

0:39

and it's large pneumoperitoneum.

0:41

We have a continuous diaphragm sign of air underneath the,

0:45

uh, um, diaphragm in the abdomen.

0:48

And then when we look closely

0:50

and we window our image,

0:51

we can see there is falciform ligament here.

0:53

So this is the football sign of, um, pneumoperitoneum.

0:58

Last but not least, this patient has a regular sign,

1:01

so we can see both sides of the, uh, of this loop

1:05

of bowel in the middle of the abdomen.

1:07

So we have gas within this loop of bowel,

1:09

but we also have gas up outside of this loop of bowel,

1:12

allowing us to see both sides of this loop of bowel.

1:14

So this is a regular sign.

1:16

So large volume pneumoperitoneum compatible

1:18

with intestinal perforation in this extremely premature, um,

1:22

almost one week old infants.

Report

Text

Faculty

Judy H. Squires, MD

Associate Professor of Radiology

UPMC Children's Hospital of Pittsburgh

Lesson

Introduction

Lesson

Neonatal Brain

Lesson

Neonatal Spine

Lesson

Neonatal Chest: Support Devices

Lesson

Neonatal Chest: Newborn Lung Disease/Complications

Lesson

Neonatal Chest: Congenital Lung Lesions and Cardiac Diseases

Lesson

Neonatal Gastrointestinal: Necrotizing Enterocolitis

Lesson

Neonatal Gastrointestinal: Proximal and Distal Obstructions

Lesson

Neonatal: Genitourinary Imaging

Case: Surgical Necrotizing Enterocolitis on X-ray