Chilaiditi sign on CT and MR

Case contributed by Sipan Mathevosian

Presentation

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

Patient Data

Age: 47
Gender: Male
X-ray

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

CT

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

MRI

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

PlayAdd to Share

Case information

rID: 46840
Case created: 19th Jul 2016
Last edited: 3rd Aug 2016
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.