Chilaiditi's anomaly

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Chilaiditi's sign

Hepatodiaphragmatic interposition of the intestine (HDI) which is interposition of bowel between the liver and the right hemidiaphragm was first described in 1865 by Cantini[1][2] and subsequently with X-ray and post mortem correlation by Beclere in 1899[3][4][5] before Chilaiditi's case series in 1910[6]. This is usually transverse colon, but occasionally small bowel too. Normally asymptomatic incidental finding, but has been associated with tranverse colon volvulus.[7][8] Occasionally seen in cirrhosis due to shrinkage of the liver.

Chilaiditi's sign 
Appearance on a radiograph (usually CXR), but be wary of confusing it with pneumoperitoneum (and vice versa).[9][10]
Chilaiditi's syndrome 
is symptomatic with compression of bowel causing nausea, abdominal pain and respiratory distress.
LogoKeyPointsBox.pngPredisposing factors for HDI[11]

Epidemiology

It is found in between is found in 0.2% to 0.000003% routine chest radiographs with a male to female ratio of 4:1 but given its predisposing causes is likely to be commoner in hospital practice and some subpopulations explaining this several orders of magnitude variation . Geriatric populations have incidence approaching 1%, learning disabilities 9%, and Iranians with pregnancy 2% and postnecrotic cirrhosis 22% [11].

References

  1. Haddad CJ, Laclé J. Chilaiditi's syndrome. A diagnostic challenge. Postgraduate medicine. 1991 Mar; 89(4):249-50, 252.
  2. Risaliti A, De Anna D, Terrosu G, Uzzau A, Carcoforo P, Bresadola F. Chilaiditi's syndrome as a surgical and nonsurgical problem. Surgery, gynecology & obstetrics. 1993 Jan; 176(1):55-8.
  3. Lekkas CN, Lentino W. Symptom-producing interposition of the colon. Clinical syndrome in mentally deficient adults. JAMA : the journal of the American Medical Association. 1978 Aug 25; 240(8):747-50.
  4. BEHLKE FM. HEPATODIAPHRAGMATIC INTERPOSITION IN CHILDREN. The American journal of roentgenology, radium therapy, and nuclear medicine. 1964 Mar; 91:669-73.
  5. Vessal K, Borhanmanesh F. Hepatodiaphragmatic interposition of the intestine (Chilaiditi's syndrome). Clinical radiology. 1976 Jan; 27(1):113-6.
  6. Chilaiditi D. Zur Frage der Hepatoptose und Ptose in allgemeinen in Anschluss an drei Fälle von temporärer, partieller Leberverlagerung. Fortschritte auf dem Gebiete der Röntgenstrahlen 1910-11;16:173-208.
  7. Orangio GR, Fazio VW, Winkelman E, McGonagle BA. The Chilaiditi syndrome and associated volvulus of the transverse colon. An indication for surgical therapy. Diseases of the colon and rectum. 1986 Oct; 29(10):653-6.
  8. Barroso Jornet JM, Balaguer A, Escribano J, Pagone F, Domenech J, del Castillo D. Chilaiditi syndrome associated with transverse colon volvulus: first report in a paediatric patient and review of the literature. European journal of pediatric surgery. 2003 Dec; 13(6):425-8.(Link to article – subscription may be required.)
  9. Bishop CC, Whitehead SM, Jackson BT. Misdiagnosis of the Chilaiditi syndrome. British medical journal (Clinical research ed.). 1987 Dec 19-26; 295(6613):1655.
  10. Iyer SG, Leow CK. Case report: Free air or colon? Annals of the College of Surgeons Hong Kong 2003; 7(4):136–138. (Link to article)
  11. a b Fisher AA, Davis MW. An elderly man with chest pain, shortness of breath, and constipation. Postgraduate medical journal. 2003 Mar; 79(929):180, 183-4.