During a routine check-up, retro-pneumoperitoneum was discovered on the lowest slices of a computed tomography (CT) chest scan in a 77-year-old female patient who was known to have Sjögren’s syndrome with lymphocytic interstitial pneumonia (fig. 1a). She had initially been treated with prednisolone that improved sicca signs and cough. The patient, who had no prior history of digestive problems, complained of abdominal discomfort and distension. She was …