Presentation
Chief complaints: cough with productive sputum, body pain for 15 days, mild shortness of breath. Clinical examination: chest bilateral lungs rhonchi
Patient Data
Both lung fields show increased bronchovascular markings.
Bilateral apical zones mild pleural thickening is noted.
Prominent aortic knuckle with unfolded aorta.
Incidental finding: bowel gas is seen under the right hemidiaphragm (Chilaiditi sign).
Case Discussion
Chilaiditi sign refers to the interposition of the bowel, usually the colon, between the inferior surface of the right hemidiaphragm and the superior surface of the liver. 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.
This finding is of significance in patients who require percutaneous transhepatic interventional procedures such as liver biopsy, tumor ablation therapy, and biliary drainage to avoid the risk of intestinal injury.
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