What causes Football sign in abdomen on supine abdominal radiograph?
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Answer:
Massive pneumoperitoneum due to perforated viscus, most frequently advanced necrotizing enterocolitis in children, or other causes including bowel obstruction with perforation, peptic ulcer disease, gastric perforation, or iatrogenic/endoscopic injury.
Why is it called so?
Resembles the oval shape of an American football (or rugby/Australian rules ball), with large central lucency outlining the peritoneal cavity and falciform ligament/median umbilical ligament visualized as linear opacities mimicking the ball’s laces or sutures.
Pathophysiology
Free intraperitoneal air from hollow viscus perforation accumulates massively within the peritoneal cavity, distending it to produce large oval radiolucency sharply interfacing with parietal peritoneum; falciform ligament becomes outlined as central linear density due to tangential positioning to x‑ray beam in supine view, enhanced in infants/small patients with relatively larger air volume.
Alternative names: None
Other associated named signs: Rigler sign, falciform ligament sign, Silver sign
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