Abstract

Despite the ever-increasing utilization of CT, a supine abdominal radiograph can still be the ‘‘presenting’’ imaging study for patients with acute abdominal pain. Although less sensitive than upright or left lateral decubitus views, a supine frontal abdomen view thus can present the initial opportunity to detect pneumoperitoneum [1]. Among the many described radiographic signs is an ‘‘inverted V’’ visible in the pelvis (Fig. 1). Superomedially directed oblique lines are thought to represent gas outlining peritoneal folds that overlie either the obliterated umbilical arteries [2], or the inferior epigastric arteries [3]. As with any imaging evidence of pneumoperitoneum, the inverted V should prompt a search for perforated viscus.

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