Role of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers

Background/Aims: The purpose of this study was to determine the value of up right chest radiography and ultrasonography in demonstrating free air of pe rforated peptic ulcers. Methology: Eighty-four patients with perforated peptic ulcers receiving bot h upright chest radiography and ultrasonography before laparotomy. The sens itivity of each modality in demonstrating free air was correlated. Results: Among the 84 patients receiving both examinations, free air was de monstrated in only 39 (46%) upright chest radiographs and 46 (55%) ultra-so nographs, the direct sign could be demonstrated in 57 (68%) patients by com bined radiography and ultrasonography. Besides, the indirect sign of ascite s could be demonstrated in 26 (31%) ultrasonographs. Conclusions: Ultrasonography is more sensitive than upright chest radiograp hy to demonstrate free air of perforated peptic ulcers, and it should be co nsidered in those patients of suspected perforated peptic ulcers with negat ive upright chest radiography. Combined methods of upright chest radiograph y and ultrasonography can increase the overall sensitivity in demonstrating free air.