Step II Pediatric Xray

[Ronin786]

Maybe a stupid question, but can anybody tell me what the bubble under the diaphragm in this X-Ray is:

I had a similar XRay in UWorld and got sidetracked thinking that it was something abnormal.

 

[evilbooyaa]

It's the gas bubble within the baby's stomach.

It's not a perforation (and free air under the diaphragm) because you can see the interface between the stomach and the diaphragm in the bottom right.

That's air under the diaphragm, bilaterally.

And this is a pretty severe one where you are seeing a vertical shift in the diaphragm due to the excess of air that is underneath it.

The second picture is pretty easy to tell the pathology.

However, compare the first picture to what you posted. Granted, the ones I posted are in an adult, but it should be the same.

Here's a link comparing a normal gas bubble to air under the diaphragm directly:

http://school.anhb.uwa.edu.au/perso...ng/ImagingIntro_files/frame.htm#slide0011.htm

 

[Ronin786]

Thanks a lot man. I can usually diagnose pneumoperitoneum by looking next to the liver (as long as I actually remember to look next the liver), but that gas bubble was giving me trouble.

Much appreciated.