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F: Notize the black frame between the diaphram and the liver and the stomach. There are unusual "black" regions next to the heart

H: Adult woman, 56-years-old, suffering from an insufficient anastomosis after hemicolectomy, high fever.

INFO/WWW: Pneumoperitoneum may be caused by perforation of a peptic ulcer, diverticulum, appendix, bowel, gall bladder or - in this case - after an insufficient anastomosis following hemicolectomy followed by air under the diaphram on erect CXR.
Mediastinitis may be caused by damage to the esophagus or - in this case - by severe retroperitoneal abscess - followed by pyopneumomediastinum.

D: Peritonitis with pneumoperitoneum (free air in the peritoneal cavity between e.g. the diaphram and liver and the stomach) and mediastinitis with air in the mediastinum caused by retroperitoneal abscess after an insufficient anastomosis following hemicolectomy

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