Chilaiditi sign on CT and MR

Case contributed by Sipan Mathevosian


47 year old man with intermittent abdominal pain. Physical exam and labs were unremarkable.

Patient Data

Age: 47
Gender: Male

Air beneath the right hemidiaphragm with faint haustral pattern may be mistaken for free air in patients with acute pain.


Colonic interposition between the liver and right hemidiaphragm is shown on CT.


Colonic interposition between the liver and right hemidiaphragm is shown on MR.

Case Discussion

Colonic interposition between the liver and diaphragm can present as pseudopneumoperitoneum on plain film and is known as Chilaiditi sign. Pneumoperitoneum and subphrenic abscess should be considered in the differential, however. Radiographic diagnosis is made by an elevated right hemidiaphragm, visible air in the colon under the diaphragm, and a depressed superior edge of the liver. This variant anatomy in a patient with abdominal pain, nausea, vomiting, or respiratory distress is known as Chilaiditi syndrome, which may be rarely complicated in cases of volvulus or perforation. 


This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center

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Case information

rID: 46840
Published: 3rd Aug 2016
Last edited: 5th Oct 2020
Inclusion in quiz mode: Included

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