Abstract
Purpose: Chilaiditi’s syndrome is a rare condition commonly diagnosed as an incidental radiological finding. The aim of this report is to show the role of SPECT-CT in this syndrome and state the functional and anatomical role of this hybrid imaging modality. 
 Materials and Methods: A case report.
 Results: A 49-year-old female patient was referred for gallium-67 citrate for a possible
 granulomatous myositis and underwent SPECT-CT of the abdomen to assess the area of decreased gallium uptake on planar images of the liver. The combined SPECT and CT modality demonstrated findings consistent with the clinical evidence of Chilaiditi’s syndrome. The anatomical part of this hybrid modality made it easier to evaluate the area of gallium lack of uptake which was due to air in the colon.
 Conclusion: This case does not only show the role of SPECT-CT in this syndrome but also suggest that the use of such modality should be considered whenever available in the evaluation of patients in whom the localization of active disease becomes imperative.
Highlights
Chilaiditi’s sign is a radiographic term that is used when the hepatic flexure of the colon is seen interposed between the liver and right hemidiaphragm.[1]
We report on a female patient with a clinical diagnosis of myopathy thought to be caused by granulomatous myositis
The use of SPECT-Computed tomography (CT) made the interpretation of our finding easier and prevented the search for differential diagnoses of decreased gallium uptake such as cysts, fibrosis, benign tumours, bile peritonitis, and liver replacement by non-Ga-67-avid lesions, amoebic abscess or a necrotic liver metastasis
Summary
Chilaiditi’s sign is a radiographic term that is used when the hepatic flexure of the colon is seen interposed between the liver and right hemidiaphragm.[1] This syndrome is a rare condition and most often an asymptomatic anomaly that is typically an incidental finding.[2] It is seen in 0.1 - 0.25% of chest X-rays, most frequently in males, and almost always in adults. Gallium-67 citrate was the agent used in an attempt to localise a site of active disease. The use of this hybrid imaging modality prevented us from looking into the differential of a ‘photon-deficient’ area on gallium imaging of the abdomen. Our case is the first in the literature to describe the finding of Chilaiditi’s syndrome using this hybrid imaging modality
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