TYPICAL SONOMORPHOLOGY AS SONOGRAPHIC EVIDENCE OF PNEUMOPERITONEUM

The correspondence of sonography and radiography to figure out a pneum operitoneum was studied in a group of 140 patients having undergone ab dominal surgery. Sonography revealed 14 (82,4%) out of 17 radiographic ally positive patients. Because of the predominant collection of free air in the right upper quadrant, the ventrolateral liver surface repre sents the most important region in search of a pneumoperitoneum. In an other 3 patients free peritoneal gas was diagnosed which was not revea led radiographically., The possibility to observe motion in real-time sonography repeatedly proved to be decisive for the certain diagnosis of free air (the shifting air under patient's movent and the immobilit y of the gas reflex under respiration). An observed ''step'' between t he air in the costophrenic sinus and the abdominal gas reflex is consi dered to be an additional sonographic sign. These results justify comb ined evaluation of a suspected pneumoperitoneum by both plain film rad iography and sonography prior to other imaging modalities.