Chilaiditi sign

Case contributed by Mohamed Salah Ayyad
Diagnosis almost certain


Recurrent attacks of dyspnea

Patient Data

Age: 60 years
Gender: Male



Marked elevation of the right diaphragmatic cupola with interposed gas-filled colonic loops between the elevated cupola and the right lobe of the liver.

Case Discussion

Chilaiditi sign is an incidental finding in the chest and abdominal radiographs with an incidence of about 0.025 to 0.28% where there is bowel, usually colon interposed between the liver and diaphragm. It is one of the causes of pseudopneumoperitoneum. Chilaiditi syndrome occurs when symptoms accompany the Chilaiditi sign.

Under normal circumstances, the fixation of the colon impedes its interposition between the liver and the right diaphragmatic cupola. Some anatomical variants such as laxity or elongation of the suspensory ligament of the transverse colon may predispose to this interposition. Functional disorders such as chronic constipation can also lead to this condition. It can result from liver cirrhosis due to atrophy of the medial segment of the left lobe.

The following criteria must be met before making the diagnosis of Chilaiditi sign:

  • elevation of the right hemidiaphragm

  • distended colonic loops between the right cupola and the liver

  • superior border of the liver inferior to the level of the left hemidiaphragm

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