Chilaiditi’s Sign/Syndrome

Hepatodiaphragmatic Interposition of the Intestine

 

General Considerations

• 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

Clinical Findings

• The “syndrome” may involve
• Abdominal pain
• Constipation
• Vomiting
• Respiratory distress
• Anorexia

Imaging Findings

• 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