ª Springer Science+Business Media New York 2016 Abdom Radiol (2016)

Abdominal DOI: 10.1007/s00261-016-0896-3

Radiology

The leaping dolphin sign

Raymond B. Dyer ,1 David J. DiSantis2
1
Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157,
USA
2
Department of Radiology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL 32224, USA

The multitude of radiologic signs purporting to reveal

pneumoperitoneum on supine abdominal radiographs
attests to the difficulty of making the diagnosis [1–4].
The ‘‘leaping dolphins’’ sign offers a particularly exotic
metaphorical example, describing intraperitoneal free
air beneath the arcuate slips of the diaphragm’s long
costal muscles [1, 3]. The gently curving collections of
gas mimicking the parallel arcs of dolphins leaping in
tandem (Fig. 1) occur more often in the right upper
quadrant (Fig. 2), but occasionally can be seen on the
left. This sign usually indicates a moderate to large
volume pneumoperitoneum, and so, it most often
accompanies at least one additional sign of free air
(Fig. 3) [1, 2, 4].

Fig. 1. Leaping dolphins (This copyrighted picture of leaping

dolphins is used with permission of the photographer,
Mr. Doug Perrine).

Correspondence to: Raymond B. Dyer; email: rdyer@wakehealth.edu

 R. B. Dyer, D. J. DiSantis: The leaping dolphin sign

Compliance with ethical standards

Funding None.

Conflict of interest The authors declare that they have no conflict of

interest.

Research involving human and animal rights This article does not
contain any studies with human participants or animals performed by
any of the authors.

References
1. Baker SR, Cho KC (1999) Plain film radiology of the peritoneal and
retroperitoneal spaces. In: The abdominal plain film with correlative
imaging, 2nd edn. Stamford, Connecticut: Appleton & Lange,
pp 87–175
2. Levine MS, Scheiner JD, Rubesin SE, Laufer I, Herlinger H (1990)
Diagnosis of pneumoperitoneums on supine abdominal radiographs.
AJR 156:731–735
3. Cho KC, Baker SR (1997) Depiction of diaphragmatic muscle slips
on supine plain radiographs: a sign of pneumoperitoneum. Radiol-
ogy 203:431–433
4. Mindelzun RE, McCort JJ (1986) The cupola sign of pneumoperi-
toneum in the supine patient. Gastrointest Radiol 11:283–285

Fig. 2. Parallel arcuate collections of gas beneath the long

costal muscle slips of the diaphragm reprise the ‘‘leaping
dolphins’’ in the right upper quadrant on this coned-down,
supine abdominal radiograph (yellow arrows).

Fig. 3. Supine radiograph of another patient with a right

upper quadrant ‘‘leaping dolphin’’ (yellow arrows). Note the
additional signs of free air, including Rigler’s double wall sign
(white arrow), the cupola sign (blue arrow), and the lucent
liver.