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September 17, 1982

Massive Extraperitoneal Air in a 71-Year-Old Woman: Occurrence During a Radiological Study

JAMA. 1982;248(11):1375-1376. doi:10.1001/jama.1982.03330110065033

History  A 71-year-old woman was referred to the radiology department for a study to be described later. During the study a large amount of gas was noted in the retroperitoneum, under the diaphragm, in the mediastinum, and in the subcutaneous tissues of the neck in chest x-ray films in the posteroanterior and lateral positions (Fig 1, left and right). Gas outlined most of the liver, the entire spleen, the psoas muscles, the right kidney, and the adrenal gland and extended laterally to the flank stripe. Mediastinal and cervical air outlined the descending thoracic aorta and border of the right side of the heart. In the lateral view the air was noted in the posterior pararenal space extending anteriorly over the liver extraperitoneally and outlining the anterior attachment of the diaphragm to the xyphoid (Fig 1, right, arrow). On the second day after the study, subcutaneous emphysema involved the face, base