title: Gas-distended stomach masquerading as free air.
abstract: Free air can be an ominous sign of bowel perforation with the fear if resulting sepsis. Several radiological signs have been described to aid in interpretation including Rigler's sign. We present a case where a large amount of free air was felt to be present in a 5 year old post craniopharyngioma resection. Clinically free air was not expected. To try and acount for these discrepant findings, the nasogastric tube was examined and found to be clogged. Once the nasogastric tube functioned, it became evident that the large amount of air was in the stomach rather than free in the peritoneal cavity. This case demonstrates a potential mimic of free air but also highlights the need to correlate radiographic findings and interpretations to the clinical state of the patient.
authors.affiliation: Department of Radiology, Westchester Medical Center, Valhalla, NY, USA. bentleys@wcmc.com
authors.forename: Stuart I
authors.initials: SI
authors.lastname: Bentley-Hibbert
authors.forename: Adele
authors.initials: A
authors.lastname: Brudnicki
mesh_terms: D000388:Air; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000601:surgery; D003951:Diagnostic Errors; D004868:Equipment Failure; D005189:False Positive Reactions; D005740:Gases; D013271:Gastric Dilatation / Q000000981:diagnostic imaging*; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D010911:Pituitary Neoplasms / Q000601:surgery; D011027:Pneumoperitoneum / Q000175:diagnosis*; D011183:Postoperative Complications / Q000175:diagnosis*; D011859:Radiography
chemical_list: D005740:Gases