Football Sign

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A radiologic finding in massive pneumoperitoneum in infants with perforated hollow organs, caused by free air accumulation in a supine upper abdomen, which imparts an ovoid, radiolucent increase in the abdominal cavity, a finding fancifully likened to the ‘pigskin’ used in American football
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The football sign was first described by R E Miller in the 1960s.
The visualisation of the football sign is indicative of a large amount of intraperitoneal air relative to the patient size, while Rigler's sign can be seen with a small amount of intraperitoneal air and is a more sensitive sign for early pneumoperitoneum.
While there are numerous causes of pneumoperitoneum, gastric perforation is more likely to result in the football sign than small bowel perforation, because gastric perforations are usually associated with release of a larger amount of free air.
It is important for the radiologist to recognise the supporting signs of pneumoperitoneum such as Rigler's sign and the football sign on supine abdominal radiographs, especially in neonates and infants where erect chest/abdominal radiographs are not always possible.
On outskirts of town, pick up football signs for Kings Park, Boscombe.
Permian players have the football signs in the front yard, a status symbol around town.
No Football signs have been put up all around the estate, built on the former ground after teenagers damaged cars and homes while practicing their skills.