Gas visible in the subcutaneous tissues around proximal MCP of the hallux, and medially around the ankle bones
Hyperinflated, large volume lungs with a narrow mediastinum and flat diaphragms.
Lungs are also hyperlucent, typical of COPD
There is moderate dilatation of the left renal pelvis and left calyces which has been attributed to a previously demonstrated renal calculus
The dense contrast within the left pelvicalyceal system however obscures this left sided calculus.
Pneumoperitoneum with air visible under both diaphragms as a result of peptic ulcer perforation.
X-ray illustrates the 'continuous diaphragm sign' - the diaphragm is not usually seen in its entirety due to the cardiac shadow.
Dilated bowel loops.
There is also Rigler's sign - both sides of the bowel wall are visible due to air outside and inside the bowel.
Dextrocardia situs inversus - Note that this is not simply dextrocardia, where the heart alone is found to be further displaced to the right of thorax than normal.
This is situs inversus, therefore all major structures have been transposed through the sagittal plane - note the gastric bubble on the RIGHT. The liver will also be located on the LEFT
For interest, the normal anatomical
Lateral translocation of tibia, disrupting left knee joint. No bony fractures
Generalised gaseous distention of the large and small bowel. No gas in the rectum.