A neonate develops sudden abdominal distension and cyanosis after resuscitation. Supine abdominal radiograph shows a large oval radiolucency outlining the entire peritoneal cavity with visible falciform ligament, resembling an American football. What does this finding signify?
- A Pneumoperitoneum from perforation ✓
- B Tension pneumothorax
- C Pneumatosis intestinalis
- D Congenital diaphragmatic hernia
Correct answer: A. Pneumoperitoneum from perforation
Explanation
The football sign is free intraperitoneal gas collecting anteriorly under the supine patient, with the falciform ligament forming the lace of the football. It indicates pneumoperitoneum from gastrointestinal perforation, a surgical emergency requiring immediate laparotomy. Pneumatosis intestinalis is gas within the bowel wall seen in necrotising enterocolitis and precedes perforation. Diaphragmatic hernia shows bowel loops within the thorax, and pneumothorax is a thoracic collection, neither producing this peritoneal gas pattern.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.