JOURNAL OF COMMUNITY HOSPITAL INTERNAL MEDICINE PERSPECTIVES
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RADIOLOGY IMAGES
Beware of Chilaiditi sign!! Abhijeet Danve, MD* and Supriya Kulkarni, MD Department of Internal Medicine, Metropolitan Hospital and New York Medical College, New York, NY, USA
*Correspondence to: Abhijeet Danve, 11322 Franklin Plaza Apt 915, Omaha, NE 68154, USA, Email: [email protected] Received: 22 May 2015; Revised: 5 June 2015; Accepted: 5 June 2015; Published: 19 October 2015
41-year-old male with a history of Down’s syndrome, seizure disorder, renal calculi, and chronic respiratory failure was admitted for complicated urinary tract infection. Chest X-ray (Fig. 1) showed elevated right hemidiaphragm. CT abdomen (red arrows Figs. 2 and 3) demonstrated interposition of colon between right hemidiaphragm and liver (Chilaiditi sign) as well as gallstones. Chilaiditi sign is an incidental radiological finding described by Greek radiologist Demetrius Chilaiditi in1910 (1). It is characterized by interposition of the colon between the right hemidiaphragm and liver. Incidence is 0.11% and most patients are asymptomatic (2). It is called Chilaiditi syndrome when this finding is associated with symptoms such as abdominal pain, distension, vomiting, anorexia, and constipation (3). Chilaiditi sign is probably due to lax suspensory ligament of colon or liver causing excessive mobility of colon. Diagnosis is suspected by chest X-ray and confirmed with CT scan. Surgery is reserved only for patients with resistant symptoms. It is important to know
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Fig. 2. Coronal CT scan image shows the interposition of the colon between right hemidiaphragm and the liver (red arrows).
Fig. 1. X-ray of chest showing air under the elevated hemidiaphragm.
Fig. 3. Transverse CT scan image shows the interposition of the colon between right hemidiaphragm and the liver (red arrows).
Journal of Community Hospital Internal Medicine Perspectives 2015. # 2015 Abhijeet Danve and Supriya Kulkarni. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 28622 - http://dx.doi.org/10.3402/jchimp.v5.28622
1
(page number not for citation purpose)
Abhijeet Danve and Supriya Kulkarni
this entity because it can be mistaken for bowel perforation and can lead to unnecessary surgical intervention.
Authors’ contributions Both the authors have participated actively in the study, have met the requirements for the authorship, and have read and approved the submitted manuscript.
References 1. Chilaiditi D. Zur frage der hepatoptose und ptose im allgemeinen im anschluss an drei fa¨lle von tempora¨rer, partieller leberverlagerung. Fortschritte auf dem Gebiete der Ro¨ntgenstrahlen 1910; 16: 173208. 2. Havenstrite KA, Harris JA, Rivera DE. Splenic flexure volvulus in association with Chilaiditi syndrome: Report of a case. Am Surg 1999; 65(9): 8746. 3. Chan SC, Law S, Chu KM. Iatrogenic Chilaiditi’s syndrome. Gastrointest Endosc 2002; 56(3): 4479.
Conflict of interest and funding The authors have no conflict of interest.
2 Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 28622 - http://dx.doi.org/10.3402/jchimp.v5.28622 (page number not for citation purpose)
æ
RADIOLOGY IMAGES
Beware of Chilaiditi sign!! Abhijeet Danve, MD* and Supriya Kulkarni, MD Department of Internal Medicine, Metropolitan Hospital and New York Medical College, New York, NY, USA
*Correspondence to: Abhijeet Danve, 11322 Franklin Plaza Apt 915, Omaha, NE 68154, USA, Email: [email protected] Received: 22 May 2015; Revised: 5 June 2015; Accepted: 5 June 2015; Published: 19 October 2015
41-year-old male with a history of Down’s syndrome, seizure disorder, renal calculi, and chronic respiratory failure was admitted for complicated urinary tract infection. Chest X-ray (Fig. 1) showed elevated right hemidiaphragm. CT abdomen (red arrows Figs. 2 and 3) demonstrated interposition of colon between right hemidiaphragm and liver (Chilaiditi sign) as well as gallstones. Chilaiditi sign is an incidental radiological finding described by Greek radiologist Demetrius Chilaiditi in1910 (1). It is characterized by interposition of the colon between the right hemidiaphragm and liver. Incidence is 0.11% and most patients are asymptomatic (2). It is called Chilaiditi syndrome when this finding is associated with symptoms such as abdominal pain, distension, vomiting, anorexia, and constipation (3). Chilaiditi sign is probably due to lax suspensory ligament of colon or liver causing excessive mobility of colon. Diagnosis is suspected by chest X-ray and confirmed with CT scan. Surgery is reserved only for patients with resistant symptoms. It is important to know
A
Fig. 2. Coronal CT scan image shows the interposition of the colon between right hemidiaphragm and the liver (red arrows).
Fig. 1. X-ray of chest showing air under the elevated hemidiaphragm.
Fig. 3. Transverse CT scan image shows the interposition of the colon between right hemidiaphragm and the liver (red arrows).
Journal of Community Hospital Internal Medicine Perspectives 2015. # 2015 Abhijeet Danve and Supriya Kulkarni. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 28622 - http://dx.doi.org/10.3402/jchimp.v5.28622
1
(page number not for citation purpose)
Abhijeet Danve and Supriya Kulkarni
this entity because it can be mistaken for bowel perforation and can lead to unnecessary surgical intervention.
Authors’ contributions Both the authors have participated actively in the study, have met the requirements for the authorship, and have read and approved the submitted manuscript.
References 1. Chilaiditi D. Zur frage der hepatoptose und ptose im allgemeinen im anschluss an drei fa¨lle von tempora¨rer, partieller leberverlagerung. Fortschritte auf dem Gebiete der Ro¨ntgenstrahlen 1910; 16: 173208. 2. Havenstrite KA, Harris JA, Rivera DE. Splenic flexure volvulus in association with Chilaiditi syndrome: Report of a case. Am Surg 1999; 65(9): 8746. 3. Chan SC, Law S, Chu KM. Iatrogenic Chilaiditi’s syndrome. Gastrointest Endosc 2002; 56(3): 4479.
Conflict of interest and funding The authors have no conflict of interest.
2 Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 28622 - http://dx.doi.org/10.3402/jchimp.v5.28622 (page number not for citation purpose)
