The liver edge silhouette. A specific sign of perforated duodenal ulcer

The purpose of this brief paper is to describe and draw attention to a little known but probably specific sign of perforation of a viscus into the hepato-renal space first noticed by the author two years ago. A search of the literature reveals only one previous mention of it, by Mann, Kirsch, Eisen, and Familaro (1956), who, reviewing a large series of intra-abdominal perforations, found it to be a reliable sign in six of their cases. It is rare, only two instances have been seen in this hospital in the past two years, but it is based upon sound anatomical precepts and appears to be diagnostic of duodenal perforation.