Answers :
What does the radiograph show ?
There is a pneumoperitoneum (free gas is seen beneath the diaphragm).
annotate pneumoperitonuem
What three lines can you identify ?
1. Nasogastric tube
annotate
2. Umbilical vein catheter (UVC)
- seen on the right side of the lumbar spine
- passes towards the head with no loop in the pelvis
- a good position is in the IVC at approx T9
annotate
3. Umbilical artery catheter (UAC)
- seen on the left side of the lumbar spine
- has a loop in the pelvis
- may be above the diaphragm (high) or at L3/4 (low)
annotate
If you are unsure of the diagnosis what further radiograph could you request which might help make the diagnosis ?
The free gas is clear on this film but if there is doubt regarding the diagnosis, a decubitus film can be taken. A decubitus film is taken with the infant lying on the left side. The free gas will rise and will be more apparent on the film. (See film below).
annotate decubitus film
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