Chilaiditi sign


A radiological finding of transposition of a loop of the large intestine in between the diaphragm and the liver.

Incidence of this radiographic finding is 0.025% to 0.28% of chest and abdominal radiographs and 1.18% to 2.4% of abdominal CT scans.

Criteria include: the right hemidiaphragm must be elevated above the liver by the intestine, the bowel must be filled by enough air to show pseudo-pneumoperitoneum, and the superior margin of the liver must be below the margin of the left hemidiaphragm.

The cause of the transposition is laxity or absence of the falciform ligament or the suspensory ligaments of the transverse colon.

Alterations in the anatomy may also result from an elongated or redundant colon secondary to constipation or congenital abnormalities.

Differential diagnosis includes pneumoperitoneum and subphrenic abscess.

Chilaiditi syndrome refers to symptoms when transposition of the large intestine causes symptoms.

Most common symptoms are abdominal pain, nausea, vomiting, constipation, respiratory distress and chest pain.

Complications include volvulus, intestinal obstruction, and perforation.

Incidence increases with age and men are 4:1 over females.

Increased incidence with mental retardation and schizophrenia.

Increased risk include abnormally high diaphragm related to phrenic nerve paralysis and muscular degeneration, decreased liver volume due to cirrhosis, COPD, pregnancy, aerophagia, ascites, and increased bowel mobility (Yin AX et al).

Treatment is conservative with nasogastric decompression, intravenous fluids, laxatives, enemas and discontinuation of any contributing medications.

If conservative management fails surgical intervention may be required.

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