• Pronounced “Ky-La-Ditty”
• Refers to the usually asymptomatic interposition of the bowel (usually hepatic flexure of the colon) between the liver and the (right) hemidiaphragm
• Seen in 0.1-0.25% of chest x-rays
• Most frequently an incidental finding
  • More often in males
  • Almost always in adults
  • May be present intermittently
• Factors contributing to its occurrence include
  • Absence of normal suspensory ligaments of the transverse colon
  • Abnormality or absence of the falciform ligament
  • Redundant colon, as might be seen with chronic constipation or in bedridden individuals
  • Aerophagia
  • Paralysis or eventration of the right hemidiaphragm
  • Patients with chronic lung disease, cirrhosis and ascites
• The “sign” refers to the usually asymptomatic presence of the interposed bowel
• The “syndrome” may involve
  • Abdominal pain
  • Constipation
  • Vomiting
  • Respiratory distress
  • Anorexia
• Chilaiditi’s Syndrome is important because it can simulate pneumoperitoneum
  • Look for the presence of haustral folds which can establish the air beneath the diaphragm is contained within large bowel
    • Left lateral decubitus abdominal films may help in this distinction
  • Concomitant pneumoperitoneum may be more difficult to diagnose
    • May require abdominal CT

Abdominal CT scan through the level of the diaphragm shows the transverse colon
(note the haustral folds) anterior to the liver in a patient with Chilaiditi's Sign