abdominal pain. Why is this an emergency? The patient has:
- a. A ruptured abdominal aortic aneurysm.
- b. An enlarged spleen.
- c. A pericardial effusion.
- d. A ruptured gastric ulcer.
- e. Acute appendicitis.
There is a huge amount of free air in the peritoneal cavity that is allowing you to see the entire diaphragm very clearly, since it is now outlined by air on both sides. Normally, the diaphragm is not seen as a line on radiographs because the soft tissues in the peritoneal cavity provide no contrasting density to outline its undersurface. Free intraperitoneal air is almost always from a ruptured viscus which itself contained air. In this case, the patient had a perforated duodenal ulcer which was treated surgically.