Images in Clinical Medicine

Falciform Ligament Sign

Po-Chen Chou, Yu-Jang Su

N Engl J Med 2017; 377: e28

DOI:10.1056/NEJMicm1613914

An 87-year-old woman with a history of hypertension and peptic ulcer disease presented to the emergency department with a 3-day history of abdominal distention, pain in the epigastrium, and watery diarrhea. She had hypotension (blood pressure of 78/49 mm Hg), and diffuse abdominal tenderness with guarding was observed on physical examination. An abdominal radiograph that was obtained with the patient in a supine position revealed the falciform ligament sign (Panel A, arrow) — a radiographic sign of pneumoperitoneum. The falciform ligament connects the liver to the anterior abdominal wall. When surrounded by intraperitoneal free air, the falciform ligament may be seen as a vertical band of soft tissue on a computed tomographic scan of the abdomen (Panel B, arrow). An emergency laparotomy was performed, and the diagnosis of a bowel perforation was confirmed; a 2-cm perforation in the duodenum was repaired. The patient was discharged from the hospital 22 days later and recovered well.

一名87岁女性高血压及消化性溃疡患者因腹胀、上腹疼痛及水样泻就诊于急诊。体格检查发现患者低血压（血压78/49 mmHg），弥漫性腹部压痛及肌紧张。仰卧位腹部X光显示镰状韧带征（图A，箭头）— 气腹的一种影像学表现。镰状韧带连接肝脏与前腹壁。当周围有腹腔内游离气体时，腹部CT扫描可见镰状韧带呈一竖直的软组织带（图B，箭头）。患者接受急诊剖腹探查术，确诊为肠穿孔；十二指肠处发现2 cm穿孔，予以修补。22天后患者出院且恢复良好。