Lee D H, Lim J H, Ko Y T, Yoon Y
Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, Korea.
AJR Am J Roentgenol. 1990 Jan;154(1):107-9. doi: 10.2214/ajr.154.1.2104691.
We describe five patients who presented with an acute abdomen in whom pneumoperitoneum was first detected by sonography. All five subsequently were proved to have a perforated viscus. In all cases, the pneumoperitoneum was seen as an echogenic line with a posterior ring-down or reverberation artifact between the anterior abdominal wall and the anterior surface of the liver. The finding was shown best in the right upper quadrant with the patient in the left lateral decubitus position. The echoes caused by the pneumoperitoneum overlapped the echoes of the lung during inspiration, but the echoes were separate during expiration. The probable cause of pneumoperitoneum was determined with sonography in four of the five patients: three had perforation of duodenal ulcer and one had perforation of gastric cancer. The fifth patient had a perforated ileum, which was not evident on the sonogram. Our experience with these patients suggests that the detection of pneumoperitoneum on sonography in patients with an acute abdomen is an important sign of a perforated viscus.
我们描述了5例以急腹症就诊的患者，他们均首先通过超声检查发现了气腹。随后证实这5例患者均存在脏器穿孔。在所有病例中，气腹均表现为前腹壁与肝脏前表面之间的一条强回声线，并伴有后方的振铃或混响伪像。患者左侧卧位时，右上腹显示该征象最佳。吸气时气腹产生的回声与肺的回声重叠，但呼气时回声分开。5例患者中有4例通过超声确定了气腹的可能病因：3例为十二指肠溃疡穿孔，1例为胃癌穿孔。第5例患者为回肠穿孔，超声检查未显示明显异常。我们对这些患者的经验表明，急腹症患者超声检查发现气腹是脏器穿孔的重要征象。
