A Woman With Generalized Abdominal Pain

An 81-year-old woman presented to the emergency department with a 4-day history of generalized abdominal pain. She denied fever, vomiting, and diarrhea. Physical examination revealed diffuse abdominal tenderness without guarding or rebound tenderness. Her medical history was significant for multiple comorbidities, including diabetes mellitus, hypertension, and stage 3 chronic kidney disease. Chest radiography demonstrated free air beneath both hemidiaphragms (Fig 1). Point-of-care ultrasound (POCUS), performed using both curvilinear and linear transducers, revealed intra-abdominal reverberation artifacts and the enhanced peritoneal stripe sign.