Chilaiditi's Sign: A Rare Finding in a Patient with Concurrent Liver Cirrhosis and Chronic Lymphocytic Leukemia.

Chilaiditi's sign is a rare radiological finding characterized by colonic interposition between the liver and the right hemidiaphragm. It is a cause of pseudopneumoperitoneum which is often mistaken for true pneumoperitoneum. In this article, we present the case of a 73-year-old female with a previous history of pulmonary tuberculosis, who reported to our hospital with progressive abdominal distension associated with early satiety, bipedal swelling, generalized weakness, worsening fatigue, and weight loss. Following evaluation, she was diagnosed with liver cirrhosis and chronic lymphocytic leukemia. Her chest radiograph also incidentally showed air under the right hemidiaphragm with haustral folds consistent with Chilaiditi's sign. Since she did not have signs of peritonitis, she was eventually treated for liver cirrhosis and chronic lymphocytic leukemia without undergoing any surgical intervention. This case report seeks to create awareness among clinicians about this rare radiological sign in order to prevent misdiagnosis leading to unnecessary surgical procedures.

Chilaiditi Syndrome Masquerading as Acute Cholecystitis.

Chilaiditi sign is an incidental radiological finding where the intestine is interposed between the diaphragm and liver. Chilaiditi syndrome (CS), characterized by gastrointestinal symptoms and Chilaiditi sign on imaging, is of important clinical significance despite its rarity given associated complications including intestinal obstruction, bowel ischemia, and perforation. While most cases involve the large intestine, we report a rare case of CS with ileal involvement complicated by small bowel obstruction, managed conservatively. Failure to recognize Chilaiditi sign or CS may prompt unnecessary surgical interventions, emphasizing the need for physician awareness to ensure accurate timely diagnosis and appropriate management.

Chilaiditi syndrome in COPD patient: A case report.

Chilaiditi syndrome is defined as the interposition of the colon between the liver and the diaphragm or abdominal wall and is known as Chilaiditi's sign on X-rays. Although rare, this procedure can lead to serious complications. Due to its infrequency and propensity for severe complications, diagnosing and differentiating this syndrome from other acute abdominal emergencies are very important for preventing unnecessary treatment or surgical procedures. We present a 72-year-old male with a history of chronic obstructive pulmonary disease (COPD) who presented to the emergency department with persistent shortness of breath, abdominal discomfort, and vomiting. Physical examination revealed chest crepitation, tenderness in the left iliac fossa, and high blood pressure. Laboratory tests revealed a positive COVID-19 status, elevated C-reactive protein level, and respiratory alkalosis. Imaging, including a chest X-ray and CT scan, confirmed the presence of bowel loops under the diaphragm, confirming the diagnosis of Chilaiditi syndrome. Collaborative management by surgical and medical teams was essential in navigating this complex condition. This case highlights the complexity of chilaiditi syndrome, which can be episodic and intermittent, in addition to the importance of recognizing Chilaiditi's sign on imaging, particularly on CT scans, to differentiate it from pneumoperitoneum. Vigilance is crucial in identifying potential complications and guiding appropriate treatment to prevent adverse outcomes.

Unveiling the Chilaiditi Syndrome: A Case Report and Management Implications.

The Chilaiditi syndrome is when the radiologic Chilaiditi sign, defined by the interpositioning of the colon between the liver and diaphragm, becomes complicated by clinical symptoms such as respiratory insufficiency or bowel obstruction. We present the case of a 70-year-old male with a history of depression, anxiety, gastroesophageal reflux disease (GERD), and post-polio syndrome, who presented with left shoulder pain, chronic weakness, and dizziness. Initial evaluation revealed hypotension and elevated lactic acid, attributed to dehydration. Further imaging identified a Chilaiditi sign, thus raising suspicion of small bowel obstruction and the Chilaiditi syndrome. Despite conservative management, the patient continued to experience elevated lactic acid levels, prompting a computed tomography (CT) angiogram to rule out bowel ischemia. No acute intra-abdominal pathology was identified, and the patient improved with hydration and bowel rest. This case highlights the challenges in diagnosing and managing the Chilaiditi syndrome in the setting of chronic comorbidities.

Chilaiditi Sign: A Rare Radiographic Encounter and Diagnostic Exploration.

This case report explores the complex diagnostic dilemma between the Chilaiditi sign and the pneumoperitoneum. The patient presented with chronic complaints of vague abdominal pain, abdominal distension, and breathlessness. A chest X-ray indicated an elevated right hemidiaphragm with transverse colon interposition, leading to the diagnosis of Chilaiditi's sign. Subsequent imaging, including abdominal ultrasound and contrast-enhanced computed tomography, revealed a large non-enhancing multilobulated multicystic mass adherent to the anterior wall of the uterus, raising suspicions of malignancy. Managed by gynecologists, the patient underwent a total abdominal hysterectomy, mass excision, and bilateral salpingo-oophorectomy. The discussion delves into Chilaiditi's sign, its historical context, and its complex pathophysiology involving intestinal, hepatic, and/or diaphragmatic components. Various anatomical and functional factors contributing to this condition are explored. This case highlights the importance of considering the Chilaiditi sign in patients with radiologic evidence of subdiaphragmatic air. It emphasizes the need for timely and accurate diagnosis to differentiate it from more severe conditions like pneumoperitoneum. Such consideration aids in optimizing management strategies and preventing unnecessary investigations.

Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report.

Chilaiditi syndrome (CS) is an uncommon case of the asymptomatic radiographic finding of an intestinal loop between the liver and the diaphragm. The most crucial phases in the diagnosis process are a thorough physical examination and precise imaging, particularly in challenging disorders such as CS. The presence of free air under the right hemidiaphragm in this syndrome, the diagnosis of which is based on radiographic imaging, might direct the start of treatment without the need for surgical intervention. An 86-year-old man, with asthma and chronic obstructive pulmonary disease (COPD) was checked out in our hospital's emergency department (ED) after experiencing nausea and vomiting. Having abdominal breathing while the patient was in an internal medicine department owing to a urinary tract infection (UTI) and acute kidney injury (AKI), he was moved to the intensive care unit (ICU). The patient was treated with respiratory physiotherapy, inhaler bronchodilator treatment, antibiotic therapy, enema, and laxatives. Medical imaging is the primary diagnostic tool for CS, guided by the symptoms. In patients like this elderly patient who was taken to ICU from internal medicine due to acute respiratory failure and abdominal breathing, when free air is detected in the subdiaphragmatic region, control should be provided with computed tomography (CT), and non-invasive mechanical ventilation should be applied.

Chilaiditi's Syndrome Mimicking Crohn's.

Chilaiditi's sign (colonic interposition) is a rare anomaly due to an abnormally located portion of the colon that is interposed in between the liver and the diaphragm. This rare anomaly is often incidentally seen on chest or abdominal radiographs. Chilaiditi's radiographic sign is usually asymptomatic, whereas the medical condition accompanied by clinical symptoms is termed Chilaiditi's syndrome. Possible causes of the syndrome include a long and mobile colon, scarring of the liver (cirrhosis), ascites, long-standing lung disease, as well as laxity of the falciform ligament. The most common clinical signs of Chilaiditi's syndrome include gastrointestinal symptoms; however, clinical presentation can vary. This report describes a case of a 21-year-old male patient who presented with a longstanding history of left upper quadrant epigastric abdominal pain with diarrhea (six to eight loose watery stools). The patient was diagnosed with Crohn's colitis and had tried a myriad of medical therapies with no adequate response. He chose to seek a second opinion and was subsequently discovered to have Chilaiditi's syndrome via computed tomography (CT) and confirmed by barium enema. The patient then elected to undergo a right laparoscopic colectomy to resolve the symptoms. By postoperative day five, all symptoms had resolved including abdominal pain and diarrhea. Therefore, it is important to consider Chilaiditi's syndrome as a differential diagnosis in persons presenting with left upper quadrant pain and symptoms of Crohn's colitis, especially those treated with adequate medical therapy without alleviation of symptoms.

Pneumoperitoneum and Chilaiditi syndrome: navigating a diagnostic conundrum.

Chilaiditi sign represents a rare condition marked by the interposition of the bowel between the diaphragm and liver, mimicking pneumoperitoneum on radiological imaging. The syndrome manifests with gastrointestinal symptoms and is often confused with more serious conditions. This case report presents a rare instance of Chilaiditi syndrome, initially misdiagnosed as pneumoperitoneum based on chest X-ray findings. The patient, a 61-year-old woman, arrived at the emergency department complaining of acute epigastric pain. Initial tests, including a chest X-ray, suggested pneumoperitoneum, but a subsequent contrast-enhanced abdominal CT-scan revealed the interposition of the right colon between the liver and diaphragm, characteristic of Chilaiditi sign. The patient's symptoms, including abdominal pain and diarrhea, were consistent with Chilaiditi syndrome. The patient was treated successfully with intravenous antibiotics and fluids, showing significant improvement within 48 hours. The report highlights the importance of differentiating Chilaiditi syndrome from other acute abdominal conditions to avoid unnecessary surgical intervention.

Primary abdominal cocoon syndrome manifesting with Chilaiditi syndrome and intestinal obstruction: A case report.

Key Clinical Message: Abdominal cocoon syndrome and Chilaiditi syndrome are rare etiologies of bowel obstruction which have to be considered in patients with obstructive symptoms. Patients can profit from surgical management rather than non-surgical approach. Abstract: Encapsulating peritoneal sclerosis or abdominal cocoon syndrome (ACS) is an uncommon cause of intestinal obstructions associated with encapsulation of the small bowel by a fibro collagenous sac. Clinical presentations of ACS are unspecific and most patients are diagnosed intraoperatively. Moreover, Chilaiditi syndrome is another rare cause of bowel obstruction defined by interposition of colon and liver. There is no reported relation between these two conditions and surgical intervention is the suggested approach for severe bowel obstruction following them individually. We present a case with both conditions and describe our approach. A 47-year-old male presented with complaints of colic abdominal pain and distention, nausea and several attacks of bilious and nonbilious vomiting, anorexia, and constipation in the last 10 days before his admission. Laboratory data were normal and abdominal X-ray showed large dilation at the distal part of the bowel without air fluid level. The patient underwent explorative laparotomy and a mass-like lesion containing necrotic bowel and a whitish spleen accompanied by a complete anterior-rotated liver was found. The encapsulated bowel and the spleen were resected followed by the complete resolution of symptoms in the patient. The intestinal obstruction caused by ACS is mostly approached by surgery to prevent the fatal sequela of this condition.

A Rare Presentation of Pseudo-Pneumoperitoneum Secondary to Chilaiditi Sign and Chilaiditi Syndrome in Two Pre-adolescent Females: A Case Series.

Chilaiditi sign is defined as the interposition of the colon or small intestine between the liver and the right diaphragm in the absence of symptoms. Chilaiditi syndrome refers to the condition where the Chilaiditi sign is associated with symptoms including abdominal pain. In this series, we present the cases of two pre-pubescent patients with these rare conditions.  A 10-year-old female with a history of autism, IgA deficiency, and constipation presented for gastrointestinal studies due to weight loss and constipation. An abdominal X-ray revealed bowel gas under the right hemidiaphragm and colonic interposition between the diaphragm and the liver, raising concerns for the Chilaiditi sign. She underwent a bowel cleanout, with studies revealing colonic dysmotility and compartmentalization of the sigmoid colon and rectum with the absence of coloanal reflex. A nine-year-old female with a history of constipation, developmental delay, and hypotonia presented with abdominal pain, vomiting, constipation, and decreased appetite. She also manifested tachypnea, abdominal distension, and abdominal tenderness, with an abdominal X-ray revealing a dilated colon interposed between the liver and diaphragm, confirming Chilaiditi syndrome. Prior gastrointestinal studies showed dilated and redundant sigmoid colon and dyssynergia. The treatment entailed rectal irrigations and catheter decompression, which led to the improvement of symptoms. Conservative treatment is the treatment of choice for patients with Chilaiditi sign or Chilaiditi syndrome. It is important to distinguish Chilaiditi syndrome, a common cause of pseudo-pneumoperitoneum, from true pneumoperitoneum, as this diagnosis warrants immediate surgical intervention. Surgical treatment is indicated when there are signs of bowel obstruction or ischemia and for cases with recurrent Chilaiditi syndrome. Raising awareness about this condition is important to reduce the incidence of misdiagnosed surgical emergencies and resulting exploratory surgeries, as well as to avoid high-risk colonoscopies. Chilaiditi sign and Chilaiditi syndrome are relatively uncommon entities, and their prevalence is very rare in the pediatric population. Hence, we believe this case series will contribute to providing clinical awareness of these major complications and avoiding invasive interventions due to the inaccurate diagnosis of these conditions as pneumoperitoneum.

Chilaiditi Syndrome: A Rare Case and Clinical Insights for Diagnosis and Management.

Chilaiditi syndrome is a rare medical condition characterized by the interposition of a hollow organ, usually the colon, between the liver and diaphragm, leading to abdominal pain, discomfort, bloating, constipation, or nausea; in more severe instances, respiratory symptoms may manifest due to pressure on the diaphragm. The exact cause remains unclear but is thought to present along with various factors such as anatomical anomalies (hepato-diaphragmatic interposition and intestinal malrotation) and chronic conditions (cirrhosis or chronic obstructive pulmonary disease). This case report presents a 78-year-old male with rapid deterioration, confusion, and mild abdominal discomfort. Clinical and radiological examinations confirmed Chilaiditi syndrome, highlighting the challenges in diagnosis. Management strategies range from conservative approaches to surgical interventions, emphasizing the need for increased clinical awareness among physicians to ensure accurate and timely interventions. This case report underscores the importance of recognizing this rare condition.

Chilaiditi Syndrome: A Case Report, Literature Review, and Proposition of a Novel Management Staging System.

Chilaiditi's sign refers to colonic interposition between the liver and the diaphragm in the right subphrenic space secondary to the relaxation of the suspensory ligaments of the right colic flexure. The diagnosis of Chilaiditi's sign is based on radiological findings with the following three criteria: 1) The right hemidiaphragm must be adequately elevated above the liver by the intestine, 2) the bowel must be distended by air to illustrate pseudo-pneumoperitoneum, and 3) the superior margin of the liver must be depressed below the level of the left hemidiaphragm. In this report, we present the case of a 49-year-old female presenting with signs and symptoms suggestive of Chilaiditi syndrome managed with laparoscopic surgery. We also present a literature review with a summary of previous studies and propose a novel management staging system for this syndrome.

An exceptional cause of dyspnea: The uncommon case report of the association between Chilaiditi syndrome and diaphragmatic eventration.

INTRODUCTION AND IMPORTANCE: Chilaiditi's syndrome, characterized by the abnormal positioning of the intestine between the diaphragm and liver, and diaphragmatic eventration, a condition marked by the permanent elevation of one side of the diaphragm, are both exceedingly uncommon medical conditions. Their co-occurrence is even rarer, with only a handful of documented cases in medical literature. CASE PRESENTATION: A 71-year-old male patient initially presented with shortness of breath and was subsequently diagnosed with both Chilaiditi's syndrome and diaphragmatic eventration. His medical history included episodes of abdominal pain, constipation, and a prior colonoscopy that revealed no abnormal findings. Thorough physical examinations and imaging studies confirmed these diagnoses, and the patient's treatment was conservatively managed with intravenous fluids and laxatives, resulting in a significant improvement in his symptoms. Subsequent regular follow-up assessments showed no recurrence of symptoms. CLINICAL DISCUSSION: Chilaiditi's sign/syndrome is a rare condition involving colon interposition between the liver and diaphragm, often diagnosed incidentally during imaging. It mainly affects older men and can cause abdominal symptoms. Management is typically conservative, but surgery may be needed if symptoms persist or complications arise, especially in cases of colonic volvulus or ischemia. When encountering diaphragmatic air, consider a differential diagnosis to avoid unnecessary surgery. Simultaneous hepatodiaphragmatic colonic interposition and diaphragmatic eventration is extremely rare, with uncertain causation. CONCLUSION: This case highlights the rarity of the combination of Chilaiditi's syndrome and diaphragmatic eventration. Conservative management led to a significant improvement in symptoms, underscoring the importance of early recognition to prevent complications.

A Case Report of Chilaiditi's Syndrome With Sigmoid Volvulus.

Chilaiditi's syndrome is the hepatodiaphragmatic interposition of the colon. It can be caused by any pathology of intestinal, hepatic, and diaphragmatic factors. Any anatomic variations or functional abnormalities can increase the development of Chilaiditi's syndrome. It is usually asymptomatic and is found indecently in radiological studies. It is treated conservatively as long as any complications do not arise. This case of Chilaiditi's syndrome was associated with sigmoid volvulus and multiple tubercles on its surface. A 35-year-old male patient presented to the outpatient department (OPD) with complaints of weight loss, bilateral flank pain, abdominal distention, decreased appetite, vomiting, and diarrhea. CT scan showed a grossly distended loop of the colon with sigmoid volvulus and Chilaiditi's sign. A laparotomy was done, sigmoid volvulus was relieved, a biopsy of tubercles was taken for histopathology, and a colostomy was done. The biopsy result showed abdominal tuberculosis. The colostomy was later reversed. Chilaiditi's syndrome is usually treated surgically because it is associated with other complications in the gastrointestinal tract. Previous studies showed the management of cases by colonic resection with primary anastomosis; however, there was one case that reported mortality due to an anastomosis leak. In this article, we present a case of Chilaiditi's syndrome associated with sigmoid volvulus and abdominal tuberculosis as seen on biopsy, which was managed surgically by colostomy followed by colostomy reversal on follow-up.

Delayed Right Diaphragmatic Hernia With Chilaiditi Syndrome: A Case Report.

Diaphragmatic hernias can be congenital or acquired and manifest as a defect thus allowing abdominal contents to protrude into the thorax through the defect. Common presentations and symptoms can include shortness of breath, nausea, vomiting, and abdominal pain. Rarely colon or small bowel is interposed between the liver and the diaphragm, Chilaiditi sign. When the Chilaiditi sign is accompanied by symptoms it is termed Chilaiditi syndrome. We present a case of a 41-year-old male who was involved in a motor vehicle accident 12 years prior and presented with a right diaphragmatic hernia and Chilaiditi syndrome. The patient presented with a 21-hour history of abdominal pain, nausea, and vomiting. A computed tomography scan of the chest and abdomen revealed the presence of Chilaiditi sign, wherein the large bowel was positioned above the liver, having herniated through a diaphragmatic defect. The patient subsequently underwent an exploratory laparotomy which confirmed an 8 x 4 cm right diaphragmatic defect. Primary repair was completed with intraperitoneal mesh. Diaphragmatic hernias pose diagnostic challenges due to their variable symptomatology and possible delayed onset. Consequently, the importance of including diaphragmatic hernia as part of the differential diagnoses for patients experiencing abdominal pain and/or difficulty breathing is highlighted by this case, especially for individuals with a distant record of trauma.

Chilaiditi Sign in a Patient With Acute Coronary Syndrome: A Case Report.

Chilaiditi sign is a radiographic finding where part of the colon is found to be between the diaphragm and liver. Chilaiditi syndrome is characterized by symptoms such as chest or abdominal pain and shortness of breath once Chilaiditi sign is found on imaging. Chilaiditi sign is typically diagnosed by CT angiography (CTA) scan although it can also be seen on X-ray imaging at times. In most cases, Chilaiditi sign does not require acute intervention, as will be seen in our patient; however, it is important to include it in the differential diagnosis when a patient presents with characteristic symptoms. We present a case of a 71-year-old female who presented with chest pressure and shortness of breath due to acute coronary syndrome; however, she was found to have Chilaiditi sign, which was diagnosed by CTA chest.

A Rare Differential Diagnosis of Air under the Diaphragm on Abdominal X-ray - Chilaiditi's Syndrome in a Child with Skin Wrinkle Syndrome.

Chilaiditi's syndrome is a rare disorder characterized by hepatodiaphragmatic interposition of the intestine. Only 30 cases of Chilaiditi's syndrome in children were reported in the literature and none in a child with skin wrinkle syndrome. Herein, we report a case of Chilaiditi's syndrome in a child with skin wrinkle syndrome.

Dilated sigmoid colon with Chilaiditi's sign mimicking diaphragmatic hernia: A case report.

INTRODUCTION: Chilaiditi's sign is a rare radiological presentation characterized by colonic interposition between the diaphragm and liver which is usually confused with conditions such as diaphragmatic hernia, pneumoperitoneum and subdiaphragmatic abscess. CASE PRESENTATION: We report a case of 55 year old male presenting with abdominal pain since a year which was associated with abdominal fullness, loss of appetite and constipation. Further investigations showed us as a case of diaphragmatic hernia but intra operatively it was found to be Dilated sigmoid colon with Chilaiditi's sign. CLINICAL DISCUSSION: It is a rare incidental finding with major preponderance in male. The intestinal, hepatic and diaphragmatic causes predispose its pathology. Conservative management is the first line of treatment but the complicated abdominal pathologies are managed by various surgical intervention. CONCLUSION: Dilated sigmoid colon along with Chilaiditi's sign can sometime mimic as Diaphragmatic hernia which can make enormous difference in our pre and post-operative diagnosis. Chilaiditi's syndrome is a rare entity so early diagnosis is of utmost benefit.

Signo de Chilaiditi, diagnóstico tomográfico / Chilaiditi Sign, Tomographic Diagnosis / Sinal de Chilaiditi, diagnóstico tomográfico

Figura 1. Tomografía Computarizada de tórax (corte coronal). Se observan ambos campos pulmonares y las cavidades cardiacas. La flecha roja señala el área hipodensa ovalada correspondiente al aire dentro de un asa de colon interpuesta entre el hemidiafragma derecho (línea hiperdensa arriba) y el borde superior del hígado (abajo), causando una depresión del borde superior del hígado. Fuente: tomada de la historia clínica, previa autorización del paciente.

Figure 1. Chest Computed Tomography Scan (coronal plane) Both lung fields and cardiac chambers are observed. The red arrow indicates the oval hypodense area corresponding to the air inside the loop of colon interposed between the right hemidiaphragm (hyperdense line up) and superior border of the liver (down), causing a depression of the superior border of the liver. Source: taken with authorization from the patient's medical record.

Figura 1. Tomografia Computadorizada de tórax (corte coronal). Observam-se ambos os campos pulmonares e as cavidades cardíacas. A seta vermelha aponta para a área hipodensa oval correspondente ao ar dentro de uma alça do cólon interposta entre o hemidiafragma direito (linha hiperdensa acima) e a borda superior do fígado (abaixo), causando uma depressão da borda superior do fígado. Fonte: obtida com permissão do histórico clínico do paciente.

Chilaiditi Syndrome Presenting as Partial Colonic Obstruction.

Chilaiditi sign is a rare incidental radiographic finding where bowel is interposed between the diaphragm and the liver, often seen as air under the right hemidiaphragm. A majority of patients with Chilaiditi sign are asymptomatic and remain so throughout their lifetime. Chilaiditi sign is recategorized as Chilaiditi syndrome if it becomes symptomatic and is a very rare etiology of bowel obstruction. As bowel obstruction confers a huge financial burden to the health care system, studies of even the rarer etiologies are of significant value. Particularly in the case of Chilaiditi syndrome, the free air under the right hemidiaphragm can lead physicians to prematurely conclude pneumoperitoneum, which would require an emergent surgical evaluation. It is through the incorporation of a broad differential and clinical presentation that physicians can decrease the inappropriate allocation of hospital resources and unnecessary surgical procedures; additionally, keeping Chilaiditi syndrome on the differential may prevent unnecessary surgical intervention, cost to the patient, and downstream complications. Bowel obstruction secondary to Chilaiditi syndrome is most commonly treated with conservative management including intravenous fluids, bowel rest, decompression, and laxatives. If the symptoms worsen and progress to full bowel obstruction, surgical intervention has shown great efficacy. We report a case of a 69-year-old male who presented to the emergency department for progressively worsening abdominal pain, nausea, and vomiting incidentally found to have colonic interposition with mild colonic dilatation on computed tomography (CT) imaging. The patient was diagnosed with bowel obstruction secondary to Chilaiditi syndrome and treated non-surgically with rapid recovery.