No free air under diaphragms?

[alicelinden]

On CXR, what is no free air under the diaphragms a sign of?

I'm guessing one possibility is that the bowels are in the way... but is there a "classic" answer to this description?

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[intern in waiting]

no free air under the diaphragm is a normal finding, free air under the diaphragm is a sign of a ruptured abdominal organ (usually)

 

[doughboy]

Just like the previous poster said, there should never be free air under the diaphragm in normal people. You check for free air under the diaphragm in patients whom you suspect a bowel perforation.

 

[Mr. happy clown guy]

Think of it this way..."free air" is "extra luminal air"...suggesting there is a luminal rupture.
Thus, "no free air" is a normal and expected finding.

 

[jdaasbo]

simply it indicates pneumoperitoneum. This is a normal finding post laparoscopic abdominal procedures (during which you have iatrogenic pneumoperitoneum).

Otherwise it may indicate (as others have suggested) a perforated viscus.

 

[Mr. H]

wow, you guys are so cool! I hope I'll be able to do that sh** in a couple years!
peace

 

[Chris_P]

Sign of recent waterskiing :wink: (but only for girls!)

Chris
<a href="http://www.dissectionroom.com" target="_blank">www.dissectionroom.com</a>

 

[Starflyr]

No *free* air is normal, but air in the fundus of the stomach is...dont know if that may be what the instructor *meant*?

Star

 

[acurarte]

Waterskiing... Good one!!!! You would get an honor grade if I was your attending!

 

[LaCirujana]

"Sign of recent waterkiing :wink: (but only for girls!)"

Uh, wouldn't that be "free fluid" in the abdomen? (It was the last time I got pimped on it. )

 

[Chris_P]

If water was getting in you'd be quite likely to get air in too (pushed in by the water perhaps) but the point is that you wouldn't see the water on Xray but the air would make its way to the top and sit under the diaphragm.

Chris
----------------------
<a href="http://www.dissectionroom.com" target="_blank">www.dissectionroom.com</a>

 

[LaCirujana]

Sorry--thinking CT. You're absolutely correct.

 

[droliver]

yeah, that waterskining factoid is one of those classic zebra factoids that you'll get pimped about. I dare say that in reality most people would still be uncomfortable attributing free-air after a water-skining accident to this phenomena & would assume there was a perforated viscus instead