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June 12, 1981

Mass Simulating Fetal Head in Pelvis of a 68-Year-Old Man

Author Affiliations

From the Radiology Service, Veterans Administration Medical Center, Bronx, NY, and the Department of Radiology, Mount Sinai School of Medicine, New York.

JAMA. 1981;245(22):2337-2338. doi:10.1001/jama.1981.03310470051030

History  A 68-year-old chronic alcoholic man with ascites had a strangulated umbilical hernia. Bowel palpated in the hernia sac was reduced. A paracentesis was also performed because of the marked ascites and abdominal distention. A supine anteroposterior abdominal roentgenogram (Fig 1) and horizontal beam and oblique supine abdominal films were then obtained.

Diagnosis  Air in an empty umbilical hernia ("pregnant male" sign).

Comment  The large circular rim density observed on the supine anteroposterior abdominal film was suggestive of a fetal head in the pelvis. A horizontal beam cross-table lateral film confirmed the presence of air in the umbilical hernia, which was displaced inferiorly by the massively distended abdomen (Fig 2). The air acted as a contrast to the margin of the hernial sac, which produced the unusual radiological appearance of the supine abdominal film. It is presumed that the air was introduced into the peritoneal cavity during the paracentesis and