Presentation
Work up for cough.
Patient Data
Emphysematous changes are seen at both lung fields more prominent at upper lobes. Mild bronchiectasis is observed at lung bases. Tiny centrilobular nodules in linear branching pattern are seen at right lung resembling Tree-in-bud appearance. In addition, several small nodules, less than 7 mm are scattered at both lungs which seems to be fibrotic nodules. There are also several atelectatic bands scattered bilaterally.
The right hemidiaphragm is relatively elevated and there is interposition of the gas-filled large bowel loop between the right hemidiaphragm and liver inferring the Chilaiditi sign.
Degenerative changes as osteophytosis are seen at the thoracic spine.
Case Discussion
The interposition of the bowel, usually colon, between the inferior surface of the right hemidiaphragm and the superior surface of the liver known as Chilaiditi sign. It may be misinterpreted as a true pneumoperitoneum resulting in unnecessary further investigations and/or therapy (so-called pseudopneumoperitoneum). The presence of pain associated with and attributed to the sign is termed Chilaiditi syndrome.
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