Cupola sign

Radiological sign in pneumoperitoneum

The cupola sign is a radiological finding indicative of the presence of free air in the peritoneal cavity, a condition known as pneumoperitoneum. This sign is typically observed on an upright chest X-ray and is characterized by the appearance of a crescent of air beneath the central tendon of the diaphragm.

Radiological Appearance

Cupola sign on X-ray

The cupola sign is best visualized on an upright chest X-ray. It appears as a radiolucent area beneath the central part of the diaphragm, often resembling a dome or "cupola." This occurs because free air in the peritoneal cavity rises to the highest point when the patient is in an upright position, which is beneath the central tendon of the diaphragm.

Clinical Significance

The presence of the cupola sign is a critical indicator of pneumoperitoneum, which often results from a perforation in the gastrointestinal tract. Common causes include perforated peptic ulcer, diverticulitis, or trauma. Prompt recognition of this sign is essential as pneumoperitoneum can lead to peritonitis, a potentially life-threatening condition requiring urgent medical intervention.

Diagnosis

The diagnosis of pneumoperitoneum using the cupola sign involves obtaining an upright chest X-ray. In some cases, additional imaging such as an abdominal X-ray or computed tomography (CT) scan may be necessary to confirm the presence of free air and to identify the underlying cause of the perforation.

Management

Management of a patient with a positive cupola sign involves addressing the underlying cause of the pneumoperitoneum. This typically requires surgical intervention to repair the perforation. In addition, supportive care, including intravenous fluids, antibiotics, and pain management, is crucial in stabilizing the patient.

Related Pages

• Pneumoperitoneum
• Peritonitis
• Gastrointestinal perforation
• Radiology