Abstract
Chilaiditi’s sign refers to the interposition of the colon (usually the transverse colon) between the diaphragm and the liver. When associated with abdominal pain it is referred to as Chilaiditi’s syndrome. Chilaiditi’s sign is rare entity with an estimated incidence of 0.025 to 0.28% worldwide. The sign occurs more frequently in males, with a male to female ratio of 4:1. Apparent pneumoperitoneum seen on imaging below the right hemidiaphragm, a life-threatening condition, may in fact be merely Chilaiditi’s sign. Awareness of this phenomenon and its consideration as a differential diagnosis is essential to prevent unnecessary laparoscopic intervention.Here we present a case of a 74-year-old male who was incidentally found to have free air under the diaphragm without symptoms of abdominal pain. After further evaluation by the radiologists and surgeons it was concluded that he had Chilaiditi’s sign and no further intervention was required. However, due to the lack of awareness of this radiographic finding patients can be subjected to unnecessary surgical intervention.
Highlights
Chilaiditi’s sign refers to the interposition of the colon between the diaphragm and the liver
Apparent pneumoperitoneum seen on imaging below the right hemidiaphragm, a life-threatening condition, may be merely Chilaiditi’s sign
There was concern for cord compression and epidural abscess. He denied any history of fever, nausea, vomiting, or abdominal pain at admission
Summary
Chilaiditi’s sign refers to the interposition of the colon (usually the transverse colon) between the diaphragm and the liver. Apparent pneumoperitoneum seen on imaging below the right hemidiaphragm, a life-threatening condition, may be merely Chilaiditi’s sign Awareness of this phenomenon and its consideration as a differential diagnosis is essential to prevent unnecessary laparoscopic intervention [1,2,3]. There was concern for cord compression and epidural abscess He denied any history of fever, nausea, vomiting, or abdominal pain at admission. The source of infection was thought to be abscess in spine, MRI cervical/thoracic/lumbar spine showed no evidence of osteomyelitis, epidural abscess or cord compression. It showed multilevel severe spinal canal stenosis worse at L4-L5 along with multilevel bilateral neuroforaminal stenosis. Small bowel obstruction, or surrounding inflammatory changes were noted on CT imaging
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
