Pneumoscrotum

Rarely, free air can extend into the scrotum through the open processus vaginalis (Fig. 7-31). This unusual sign of large pneumoperitoneum occurs only in males. It is anatomically interesting but never crucial for the diagnosis.

Pneumoscrotum

Fig. 7—28. Ligamentum teres fissure sign with less than 1 mL of air seen on supine film.

(a) On this plain radiograph, a tiny lucency above the 12th rib medially (arrowhead) represents free air trapped in the fissure. Anterior superior bubbles are also seen laterally.

(b) On CT, note the posterior position of air (arrowhead) in the fissure, behind the left portal vein. Small anterior superior bubbles are also present, separated from each other and situated ventral to fluid in the peritoneal space. (From Cho et al.5)

Fig. 7—28. Ligamentum teres fissure sign with less than 1 mL of air seen on supine film.

(a) On this plain radiograph, a tiny lucency above the 12th rib medially (arrowhead) represents free air trapped in the fissure. Anterior superior bubbles are also seen laterally.

(b) On CT, note the posterior position of air (arrowhead) in the fissure, behind the left portal vein. Small anterior superior bubbles are also present, separated from each other and situated ventral to fluid in the peritoneal space. (From Cho et al.5)

Left 12th Rib

Fig. 7—29. Air in the left hepatic bile duct.

(a) The two tiny lucencies overlying the 11th rib (arrowheads) on supine film represent air within the left bile duct, indistinguishable from a tiny free air collection in the ligamentum teres fissure. Note pneumobilia in the common bile duct seen as a subtle tubular lucency (arrow) and also two small anterior superior bubbles of free air superolaterally.

(b) CT scan confirms the location of air in the left bile duct (arrowhead). Note its anterior position relative to the portal vein.

Fig. 7—29. Air in the left hepatic bile duct.

(a) The two tiny lucencies overlying the 11th rib (arrowheads) on supine film represent air within the left bile duct, indistinguishable from a tiny free air collection in the ligamentum teres fissure. Note pneumobilia in the common bile duct seen as a subtle tubular lucency (arrow) and also two small anterior superior bubbles of free air superolaterally.

(b) CT scan confirms the location of air in the left bile duct (arrowhead). Note its anterior position relative to the portal vein.

Fig. 7—30. Isolated left upper quadrant free air.

Free air has collected under the left hemidiaphragm but within the peritoneal cavity (arrow).

Pneumoscrotum

Fig. 7-31. Pneumoscrotum.

(a) A digital supine radiograph demonstrates a large rounded gas collection overlying the right pubic bone (arrow). It was confined in the scrotum and represents an extension of intraperitoneal free air. Rigler's sign is demonstrated as well.

(b) Digital cross-table lateral radiograph demonstrates that the caudal gas collection is within the scrotum.

(c) On a corresponding CT image, the pneumoscrotum is seen projecting anterior to the symphysis pubis. (From Baker and Cho.6)

Pneumoscrotum

Fig. 7-31. Pneumoscrotum.

(a) A digital supine radiograph demonstrates a large rounded gas collection overlying the right pubic bone (arrow). It was confined in the scrotum and represents an extension of intraperitoneal free air. Rigler's sign is demonstrated as well.

(b) Digital cross-table lateral radiograph demonstrates that the caudal gas collection is within the scrotum.

(c) On a corresponding CT image, the pneumoscrotum is seen projecting anterior to the symphysis pubis. (From Baker and Cho.6)

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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