Cáceres’ Corner Case 242 – SOLVED

Dear friends, welcome back!

Today I am showing a straightforward case to ease you into the new season. Promise I will not mention Covid-19 at all.

Today’s case is a pre op PA radiograph for knee surgery in a 47-year-old woman.

What do you see?

Come back on Friday to see the answer!

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Lung and mediastinum do not show any relevant findings. An isolated air-fluid level is visible in the left upper quadrant of the abdomen (A, arrow). The inner border of the cavity is smooth. The gastric bubble is visible under the left hemidiaphragm (A, red arrow).

Given that the patient is asymptomatic, an abdominal abscess or bowel obstruction/ volvulus can be safely excluded. A large intestinal diverticulum could be a possibility. I suspected a more mundane diagnosis: a review of the clinical history discovered that an intragastric balloon had been inserted fourteen months earlier.

Final diagnosis: air-fluid level in an intragastric balloon for morbid obesity
Congratulations to all of you who detected the air-fluid level. Kudos to Flemming Ghomsen who came close to the diagnosis.

Intragastric balloons for bariatric surgery may be filled with air or with saline. In the second case they may present an air-fluid level due to room air mixing during the injection of fluid.

Teaching points:

1. Remember to look under the diaphragm. You may discover interesting findings.
2. In your differential diagnosis always include iatrogenesis as a possible cause.

14 thoughts on “Cáceres’ Corner Case 242 – SOLVED

  1. There is a single hydroaeric level in the left upper zone of the abdomen. Probably there is no gas bubble in the stomach.
    Slightly prominent shadow of the ascending aorta and increased density of the left hilum.

  2. The left lung hilum is elevated a little and deformed. Near left upper bronchus projection slight ggo attenuation (II anterior rib part).
    The air in abdomen- suggesting bowel constipation?

  3. Por debajo de la cámara gástrica se ve un gran nivel hidroaereo en hipocondrio izquierdo. Podría ser alguna lesión quística del páncreas o bazo? En una paciente asintomática no creo que puede ser intestino…

  4. The two fluid levels in abdomen need further investigation e.g abdominal CT. One would be normal = a filled ventrikel

  5. Hidroareous level located in the left base above the gastric hidroaereous level. Could it be a small hernia, Bochdalek hernia ( assimptomatic patient).

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